Background/Purpose: Depression affects as many as 30% of SLE patients.  Most studies of risk factors for depression among SLE patients have been cross-sectional, and thus unable to identify risk factors prospectively.  The aim of this study was to identify the risk factors that preceded incident depression in a large prospective longitudinal cohort of patients without a history of depression.

Methods: A prospective study was performed using data from the Hopkins Lupus Cohort.  Demographic variables, SLE manifestations, laboratory tests, Physician’s Global Assessment (PGA), Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI), cumulative organ damage (SLICC/American College of Rheumatology Damage Index (SDI) and depression events were recorded at enrollment and each quarterly visit. A patient was considered to have depression if (1) there was a record of persistent depression (two or more mentions of depression separated by several weeks in rheumatology clinic notes) and/or a diagnosis of affective disorder was made by a psychiatric professional and (2) treatment for those symptoms with psychotherapy or antidepressant medications was documented.   Rates of incident depression were calculated overall, and in subgroups defined by demographic and clinical variables.  Adjusted estimates of association were derived using pooled logistic regression.

Results: The analysis was based on 1609 cohort members who did not have a history of depression prior to joining the cohort.  Of these, we found that 282 (17%) experienced a first depression episode during follow-up.  The incidence of depression was 29.7 episodes per 1000 person years.  In the multivariable analysis, recent SLE diagnosis, non-Asian ethnicity, disability, cutaneous activity, longitudinal myelitis and higher doses of prednisone were independent predictors of incident depression (Table 1).

Table 1.  Independent predictors of incident depression in the Hopkins Lupus Cohort based on a multivariate model

Variables	Comparison	Adjusted   Rate Ratio (95%Confidence   Interval)	P-value
Time   since SLE dx	Per   10 year difference	0.   7 (0. 5, 0. 9)	0.0006
Ethnicity	East Asian   vs. others	0.   1 (0. 01, 0. 8)	0.031
Disability	Yes vs. no	1. 4   (1. 0, 1. 8)	0.034
Income	Income   >100,000	0.   7 (0. 5, 1. 1)	0.15
Year of   enrollment	Year   after 2005	0.   6 (0. 5, 0. 8)	0.0008
Recent Cutaneous activity	Some   vs. none	1.   7 (1. 2, 2. 2)	0.0008
History of longitudinal myelitis	Yes   vs. no	4.   5 (1. 6, 12. 2)	0.0033
Recent   dose of prednisone	20   mg/day+ vs. less	2.   0 (1. 3, 2. 9)	0.0006

Conclusion: These results suggest that depression in SLE is multi-factorial, with only certain types of SLE activity (skin and myelitis) playing a role.  Interestingly,  prednisone exposure appeared to increase the risk, even after adjustment for disease activity.  This provides yet another motivation for prednisone sparing in management of SLE patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prednisone-is-a-risk-factor-for-incident-depression-in-systemic-lupus-erythematosus/