Background/Purpose: Depression is among the most common neuropsychiatric manifestations in SLE with a prevalence reported to be up to 75% in some studies. Depression in SLE patients has been shown to adversely affect health-related quality of life and increase work disability. The causes of depression in SLE are unclear and various sociodemographic and disease-specific factors have been identified. However, conflicting results have been reported in part because of methodologic issues and failure to account for all potentially important covariates. In this study, we examined the association of moderate to severe depression with socioeconomic status, disease activity, disease severity, treatment, and cognitive performance in patients with SLE.

Methods: Patients with SLE fulfilling the American College of Rheumatology criteria were recruited. All patients had detailed sociodemographic data collected and were evaluated for depression with the Beck Depression Inventory (BDI), for disease activity (SLEDAI-2K), SLE damage with the SLICC Damage Index (SLICC-DI), pain (10 cm visual analogue scale), and cognitive function by the Automated Neuropsychologic Assessment Metrics (ANAM), a symbol-based computerized testing program measuring multiple cognitive domains. Prednisone and immunosuppressive use as well as use of other potentially psychoactive medications were captured as well.

Results: In total, 99 patients were evaluated. Mean age was 46.4 (±12.1) years with a female preponderance (93% vs 7% men). BDI score ranged from 1 to 52 (mean 17±12). Moderately or severely depressed patients, defined by a BDI score ≥20 or BDI≥ 29 respectively, comprised 31.3% of patients; of these 13.1% had moderate and 18.2% severe depression. Cognitive dysfunction was identified in 24.5%. Mean SLEDAI-2K scores were 5.1 (±4.7) and mean SLICC-DI scores were 2.4 (±2.1). Low annual income defined as < $20, 000/year was reported by 37% of patients and mean pain severity was 3.5/10 (±2.4). Using logistic regression, SLEDAI-2K scores and pain severity were found to be independently correlated with moderate to severe depression in patients with SLE (p-values of 0.0078 and <0.0001 respectively). Low annual income showed a potential association (p=0.0902) and, in multiple linear regression using the actual BDI scores, was significantly associated (p=0.04). No independent associations were found between cognitive dysfunction, SLICC-DI, demographic or treatment characteristics (including prednisone) and depression in our group of SLE patients.

Conclusion: Patients’ pain severity, disease activity as measured by SLEDAI-2K and low-income level are associated with the development of moderate to severe depression in patients with SLE. The first two of these are potentially modifiable.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/moderate-to-severe-depression-in-patients-with-systemic-lupus-erythematosus/