Background/Purpose:

Depression is common in SLE but most previous studies utilized self-rated scales for evaluation. Formal diagnosis of depression was not established by psychiatric interviews. This study was conducted to determine the prevalence of depressive disorders, severity of depressive symptoms and the associated risk factors in Chinese patients with SLE.

Methods:

Adult patients who fulfilled ≥4 ACR criteria for SLE were randomly recruited from the rheumatology out-patient clinics and hospital admissions in a 6-month period. Psychiatric disorders were diagnosed through a direct interview by a designated psychiatrist using the Chinese-bilingual Structural Clinical Interview for DSM-IV Axis I disorders, patient research version (CB-SCID-I/P). The severity of depressive symptoms was assessed by the Hamilton Depressive Rating Scale (HAM-D). Patients were asked to complete the Beck Depression Inventory (BDI), Medical Outcomes Study Social Support Survey (MOS-SSS-C) and the WHO Quality of Life Measure-Abbreviated Version. SLE disease activity (SLEDAI), organ damage (SLICC/SDI) and socio-demographic were collected and correlated with the presence of psychiatric disorders. Logistic regression was used to study the risk factors for psychiatric disorders in SLE.

Results:

175 SLE patients were studied (95% women, age 39.2±12.4 years, SLE duration 10.3±6.7 years). Twenty-seven (15.4%) and 37 (21.1%) patients were diagnosed as having a current depressive (52% major depressive disorder, 22% dysthymia) and anxiety (35% generalized anxiety, 14% panic, 14% phobia, 8% adjustment disorder) disorder, respectively. Patients with depressive disorders, as compared to those without any psychiatric disorders, had higher SLE activity (p=0.03), were more likely to have a history of psychiatric diagnosis (p<0.001) and receive financial assistance from the Government (p=0.04). Independent factors associated with a current depressive disorder were SLEDAI score (1.13[1.02-1.24] per point; p=0.02), perceived poor social support (p=0.03) and a past history of psychiatric disorders (p=0.003). On the other hand, being separated/divorced (β=0.19; p=0.02), higher SLEDAI score (β=0.16; p=0.02), shorter SLE duration (β= -0.18; p=0.02) and a history of psychiatric disorders (β=0.18; p=0.01) were independently associated with higher HAM-D scores, which reflected the severity of depression. Depressive disorders and severity of depression were associated with poorer quality of life. ROC analysis showed a cut-off of 14 points of the self-rated BDI had a sensitivity of 89% and a specificity of 83% for providing good psychometric property for differentiating a current depressive disorder from those without.

Conclusion:

Depressive disorder is prevalent in Chinese patients with SLE. Independent risk factors include more active disease, perceived poor social support and a past history of psychiatric disorders. Patients with more active SLE, shorter disease duration, a past history of psychiatric disorders and being separated are associated with more serious depressive symptoms. The self-rated BDI provides a good screening tool for identifying depressive disorders in SLE patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-and-risk-factors-of-depressive-disorders-in-chinese-patients-with-systemic-lupus-erythematosus-sle/