Session Information
Date: Sunday, November 13, 2016
Title: ARHP I: Exemplary Abstracts
Session Type: ARHP Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose:
Depression is common in women with SLE. Low socioeconomic status (SES) has been associated with prevalent depression, but the longitudinal relationship between SES and onset of depression has not been examined. We assessed poverty, income, education, and subjective financial strain (FS) as predictors of incident depression in the UCSF Lupus Outcomes Study (LOS).
Methods: Data were from the 2010-2015 cycles of the LOS, obtained through annual structured phone interviews of individuals with confirmed SLE. Depression was assessed with the Center for Epidemiological Studies Depression Scale (CESD), using a validated cutoff value (≥ 23) for major depressive disorder. Women interviewed in ≥ two consecutive cycles, with scores < 23 in the first cycle (T1), were included. Participants’ level of FS was classified as High, Moderate, or None based on responses to 3 questions on current and anticipated FS (Table 1). Generalized estimating equations were used to assess the impact of educational attainment, poverty (≤ or > 125% of federal poverty level), income, and FS at T1 on the risk of incident depression the next year (T2), while adjusting for age, race, marital status, current smoking, obesity, physical functioning, disease duration, and T1 CESD score, self-reported disease activity (Systemic Lupus Activity Questionnaire; SLAQ) and damage (Brief Index of Lupus Damage; BILD).
Results:
682 women (mean age 51±13.6, SLE duration 18 ±8.9 years) contributed 2,097 observations. 45% were college graduates; 13% were living in poverty. 19% had High FS, 47% Moderate FS, and 34% No FS. High FS was reported by 61% of those in poverty, but also 13% of those not in poverty (Table 1).
166 women had 184 episodes of incident depression (rate=8.8/100 person-years). Depression occurred in 40% of those with High FS at T1, 24% with Moderate FS, and 16% with No FS. In univariate analysis, poverty, lower income and education, higher T1 SLAQ, BILD, and CESD scores, and high FS were each associated with onset of depression (Table 2); race/ethnicity was not. Neither poverty, income, nor education remained significant in multivariate analyses, but FS did. In the final model, odds of developing major depression were nearly two times higher for those with High FS compared with None (OR=1.89, 1.09-3.28).
Conclusion:
In this community-based cohort of SLE, the annual incidence of depression was 9%, and high financial strain (FS) was a significant predictor, even after controlling for disease factors and other measures of SES. Determining specific, modifiable sources of FS in SLE patients may help identify those with elevated risk of depression.
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Table 1: Levels of Financial Strain by Poverty Status and Educational Attainment |
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High Financial Straina |
Moderate Financial Strainb |
No Financial Strainc |
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All Participants |
130 (19%) |
320 (47%) |
232 (34%) |
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Poverty Status1 |
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Poverty |
54 (61%) |
28 (32%) |
6 (7%) |
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Not in poverty |
74 (13%) |
287 (50%) |
218 (38%) |
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Educational Attainment |
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No college degree |
92 (25%) |
190 (51%) |
93 (25%) |
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College degree |
38 (12%) |
130 (42%) |
139 (45%) |
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1 Missing for 15 individuals: two high-strain, five moderate-strain, eight no-strain a Responded as “Very Likely” to experience actual hardships (i.e. inadequate food, housing, or medical attention) in the next two months; OR “Very Likely” to need to reduce standard of living to the bare necessities in the next two months; OR “Very or Extremely Difficult” to live on current household income. (Vinokur A, Caplan RD. J Appl Soc Psychol. 1987 Dec;17(12):1007–24) b Responses were a combination of “Somewhat Likely or Not Too Likely”, “Not at all Likely”, “Difficult or Somewhat Difficult”, and “Not at all Difficult” c Responded as “Not At All Likely” to experience actual hardships (i.e. inadequate food, housing, or medical attention) in the next two months; AND “Not At All Likely” to have to reduce standard of living to the bare necessities in the next two months; AND “No Difficulty” living on your current household income |
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Table 2: Predictors of the Development of Depression over One Yeara |
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Univariate analyses, OR (95% CI) |
Multivariate analysisb, OR (95% CI) |
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Age |
1.00 (0.99-1.01) |
1.00 (0.98-1.02) |
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Poverty Status |
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Living in poverty (≤ 125% of federal poverty level) |
2.33 (1.53-3.54)* |
1.00 (0.57-1.73) |
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Not in poverty (reference) |
– |
– |
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Education |
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No college degree |
1.60 (1.13-2.26)* |
1.01 (0.67-1.53) |
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College degree (reference) |
– |
– |
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Financial Strain |
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High |
2.53 (1.81-3.52)* |
1.89 (1.09-3.28)* |
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Moderate |
1.16 (0.87-1.53) |
1.42 (0.93-2.18) |
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None (reference) |
– |
– |
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*significant at p < 0.05 a Other significant predictors were disease activity (SLAQ score) and baseline CES-D score; race/ethnicity was not significant
b Covariates were race/ethnicity (White, Hispanic, African-American, Asian-American, or Other), marital status, obesity (BMI ≥ 26.8 kg/m2), current smoking status, SF-36 physical functioning score, SLE disease duration, baseline CES-D score, disease activity (SLAQ score), and disease damage (BILD score) |
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To cite this abstract in AMA style:
McCormick N, Trupin L, Yelin EH, Katz PP. High Financial Strain, but Not Poverty or Lower Education, Increases the Risk of Incident Depression in Systemic Lupus Erythematosus (SLE) [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/high-financial-strain-but-not-poverty-or-lower-education-increases-the-risk-of-incident-depression-in-systemic-lupus-erythematosus-sle/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/high-financial-strain-but-not-poverty-or-lower-education-increases-the-risk-of-incident-depression-in-systemic-lupus-erythematosus-sle/