Background/Purpose: Although depressive symptoms are prevalent in persons with SLE, no studies to date have evaluated psychotherapy approaches in persons with SLE who also have comorbid depression.

Methods: Ninety persons with SLE with comorbid depression were randomly assigned to receive 8 weekly individual sessions and 3 monthly booster sessions of Mind-Body Skills Training (MBST, n=45) or Supportive Counseling/Symptom Monitoring (SCSM, n=45). SLE was defined by 1997 ACR criteria and depression was defined by Quick Inventory of Depressive Symptomatology – clinician interview version (QIDS-C) diagnostic criteria and Center for Epidemiology Studies Depression (CESD) scale score of >/=16. The MBST protocol included elements of cognitive-behavioral therapy and mindfulness meditation methods and principles. The SCSM protocol resembled traditional supportive, non-directive counseling but with a focus on topics of particular interest to persons with SLE, such as living with chronic illness, and communication with family and heathcare providers. Both interventions included information on SLE and depression as well as goal setting, and were delivered by trained, experienced psychotherapists. Participants completed study evaluations at baseline, mid-treatment, end of intervention, and 6 and 12 month follow-up. Mental health outcomes (CESD, QIDS) are reported here. Data were analyzed using generalized mixed effects models.

Results: The average age of participants was 49 years (+/- 12), 92% were females, and 23% were African American or other non-white race. Of the 90 persons enrolled, 73 (81%) completed the study. Levels of depressive symptoms in the two groups did not differ at baseline, and were in the range of moderate to severe (MBST CESD=29.7 +/- 6.4, SCSM CESD=30 +/- 6; MBST QIDS=12 +/- 3.4, SCSM QIDS=11.6 +/- 3). Both MBST and SCSM resulted in improvement in self-reported depressive symptoms (CESD) [time effect F(4,286)=44, p<.001] with a marginally significant group x time effect in favor of SCSM [F(4,286)=2, p=.07]. Likewise, both groups improved on QIDS [time effect F(4,284) = 78, p<.001], and there was not a significant group x time effect. At the 12 month follow-up evaluation, CESD scores averaged 21.3 (SD=8) for MBST and 20.2 (SD=6.5) for SCSM, indicating that, despite improvement, participants continued to report some symptoms consistent with depression and/or chronic illness. QIDS scores at 12 month follow up averaged 5.5 (SD=4.6) for MBST and 3.6 (SD=2.6) for SCSM, which is consistent with ‘no’ to ‘mild’ depression.

Conclusion: We found that both MBST and SCSM resulted in improvement in depressive symptoms in persons with SLE. Skills training was not superior to supportive counseling. Clinical diagnostic interviews indicated ‘no depression’ to ‘mild’ levels of depression at follow-up, whereas participants continued to self-report symptoms at follow-up, perhaps due to overlap between SLE and depressive symptoms such as lack of energy and difficulty concentrating. Psychotherapy approaches tailored to SLE may benefit many SLE patients who experience comorbid depression.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mind-body-skills-training-and-supportive-counseling-for-depression-in-sle-positive-effects-in-a-randomized-controlled-trial/