Background/Purpose: Lupus erythematosus (LE) is a complex autoimmune disease with heterogeneous manifestations ranging from life-threatening multi-organ inflammation in systemic lupus erythematosus (SLE) to limited skin disease in cutaneous LE (CLE).Comorbid mental health disorders have been extensively reported in SLE patients, and some limited data suggests a similar trend for those with CLE. A recent meta-analysis reported a depression and anxiety pooled prevalence in SLE of 35.2% and 24.2%, respectively, while a Danish nationwide cohort study found a two-fold increased risk of depression in patients with cutaneous or systemic LE compared with the general population. A study in the U.S. indicated that 34.7% of patients with CLE seen in a dermatology clinic had depressive and/or anxiety symptoms in need of psychiatric intervention. Although studies suggest a high rate of depressive and anxiety symptoms among people living with SLE, none have reported potential differences in depression and anxiety risk among those with cutaneous involvement. We aim to identify the prevalence of depression and anxiety symptoms in need of further evaluation in patients with lupus erythematosus and perform subset analysis based on cutaneous involvement.

Methods: Patients of 18 years of age and older with a diagnosis of lupus erythematosus, systemic, cutaneous or both, managed at a Multidisciplinary Lupus Clinic, were invited to participate in the study and complete the PHQ-9 and GAD-7 questionnaire. Chart review was performed to extract sociodemographic data, lupus related history, work-up and management as well as medical history. Translated versions of the questionnaires were available in Spanish, French and Portuguese. For both PHQ-9 and GAD-7, a score equal or higher to 10 was considered a positive screen prompting further intervention. For patients with a positive screen on either questionnaire, result was discussed with them and, if patient was not actively followed by a mental health provider, a referral was placed to behavioral health services. If patient responded positive to PHQ-9’s item concerning suicidal ideation, same-day psychiatric evaluation was pursued. The prevalence of anxiety and depressive symptoms in patients with lupus erythematosus was analyzed. We then analyzed patients with isolated CLE vs. SLE with CLE using chi-square test.

Results: A total of 110 patients received the PHQ-9 and GAD-7 questionnaires. Of these, 29 patients (28.4%) screened positive for anxiety and 42 patients (38.2%) for depression. When comparing patients with isolated CLE vs. SLE with CLE, we found a statistically significant increase of 50% (p-value=0.0077) in depressive symptoms among patients with SLE and CLE. Anxiety symptoms did not differ among the compared groups.

Conclusion: The results are consistent with previous prevalences described for LE patients with anxiety and depressive symptoms. Subset analysis by cutaneous involvement suggests that patients with both systemic and cutaneous involvement suffer from more depressive symptoms than those with isolated cutaneous involvement. This study highlights the importance of screening for mood disorders in patients with lupus, in particular patients with systemic disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mental-health-of-lupus-erythematosus-patients-managed-in-an-academic-safety-net-clinic/