Background/Purpose:   Social support (SS) is instrumental in the mental and physical well-being of people with systemic lupus erythematosus (SLE).  Moreover, SS contributes to overall health by providing a buffer from the adverse effects of stress.  This is especially salient for people with SLE who may experience a wide-range of physical and psychological disease stressors.  These stressors combined with other risk factors can contribute to suicidal ideation (SI). We examined the impact of perceived social support on suicidal ideation in SLE patients from the Georgians Organized Against Lupus (GOAL) Cohort. 

Methods:   We examined cross-sectional data from the GOAL Cohort, a large population-based cohort of validated SLE patients from metropolitan Atlanta, Georgia.  GOAL participants responded to a variety of validated self-administered tools on health outcomes.  The Systemic Lupus Activity Questionnaire assessed disease activity.  The Patient Health Questionnaire-9 assessed depression severity, including the presence and duration of SI during the preceding two weeks. The emotional support question from the Behavioral Risk Factor Surveillance System assessed the perceived adequateness of SS received. Those who responded positively for SI were further contacted, provided with depression management resources, and probed for current SS resources.  Logistic regression was used to examine the factors associated with SI.   

Results:   Of 600 SLE participants studied (93.3% women, mean age 48.8 [SD 12.8], 78.3% Black, mean disease duration 16 years [SD 9.6], and 68% uninsured), the average PHQ-9 score was 7.8 (SD 6.2), indicating mild to moderate depression.  SI was present in 67 (11%) of GOAL participants.  Significant differences were found in SS received, disease activity and poverty level between participants with and without SI. 

Among the 67 with SI, only 23.4% reported visiting a psychologist, psychiatrist, or mental health counselor during the past 12 months.  Thirty-one with SI were contacted. Many depended on family, friends or support groups (35%), or pastors, counselors, or physicians (25%) for SS. Moreover, 40% reported having no SS resource.

Conclusion: In a population-based cohort with large numbers of minorities and uninsured, depression was highly prevalent, with a significant proportion contemplating suicide.  After controlling for other risk factors, such as socio-demographics and disease status, those with perceived inadequate social support, living in poverty, or with greater disease activity were at higher risk for SI. Further development and recognition of SS resources to which SLE patients can be referred are warranted, especially in socioeconomically disadvantaged communities.