Depression persists in most lupus patients despite therapies, changes in disease activity
The majority of patients with systemic lupus erythematosus experience persistent depression despite disease activity changes and use of medications for mood disorders, pain and lupus, according to data published in Arthritis Care & Research.
The researchers also found that severe depression is more common in Black patients than white patients, which “suggests that the role of disparities in health care and social determinants of health may be an important contributor.”
“In our Washington University Lupus Clinic, we have a long-standing interest in improving the experience of living with SLE for our patients,” Sara R. Kellahan, MSN, APRN, of the Washington University in St. Louis School of Medicine, told Healio Rheumatology. “One of the issues we and others have observed is the discordance between clinical improvements — such as disease activity — and quality-of-life improvements.”
“While numerous other studies have examined the relationship of depression and SLE, most of these data come from cross-sectional studies, which only can determine associations at a single time point,” she added. “Given variation over time that patients with SLE experience, we have been collecting various patient-reported outcomes over the past 7 years to understand whether changes in these outcomes occur, and in what domains do these changes occur.”
To analyze the longitudinal course of depressed affect in patients with SLE, and to examine the link between depressed affect and SLE disease activity, Kellahan and colleagues conducted a study of 256 patients treated at the Washington University Lupus Clinic, in St. Louis. Participants included adults with either American College of Rheumatology- or Systemic Lupus International Collaborating Clinics (SLICC)-classified SLE who were treated between February 2015 and January 2020.
Patients’ depression symptoms were assessed at each visit using the Center for Epidemiologic Studies Depression Scale, Revised (CESD-R), while SLE disease activity was measured using the SLEDAI2K Responder Index-50 (S2K RI-50). Data analysis included group-based trajectory modeling (GBTM) and linear mixed models.
For this analysis, the researchers included only the 144 participants who completed a depression assessment during at least three visits over a maximum of 48 months. Among this group, 56.3% were Black and 38.9% were white.
According to the researchers, the GBTM resulted in five unique groups of patients with consistent trends of depression over time. Participants in groups four and five — which each included 44 individuals, for a combined 61.2% of the analysis population — demonstrated CESD-R scores consistent with depressed affect and major depression, respectively. The average CESD-R scores at baseline were 20.8 in group four and 36 in group five.
Among the patients in group five — those with CESD-R scores consistent with major depression — 72.7% were Black and 25% were white.
Lastly, the researchers noted an association between SLEDAI disease activity and depression scores in the multivariate analysis, but not in the GBTM or univariate analysis.
“A huge takeaway from this study is the persistence of depression in patients with SLE,” Kellahan said. “Though disease activity in SLE patients fluctuates over time, depression scores did not show evidence of these same sorts of fluctuations. Further, the high incidence of Black participants among those with worse depression scores highlights a notable disparity.”
“It is essential that we begin to assess for and better understand the impact of disparities and social determinants of health on our patients,” she added. “It is a priority that we consider not just their disease, but also their mental health and other factors that affect quality of life. It is so important that we, as health care providers, think about our patients holistically. If we are treating a person’s disease but missing that they are persistently depressed, are we really caring for that patient?”