Background Depression is one of the most commonly reported neuropsychiatric symptoms in systemic lupus erythematosus (SLE) patients. However, the prevalence of depression in relation to the general population and its relationship with SLE disease characteristics are still largely unkown.
Objectives To estimate the prevalence of depression in subjects with SLE in relation to the general population and to unravel the relation between depression and SLE disease characteristics.
Methods We studied 102 patients with SLE (mean age 44.4 yrs, 88% female, mean disease duration 7.8 yrs), all fulfilling the ACR classification criteria for SLE. Severity of SLE was determined with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and the Systemic Lupus International Collaborative Clinics Damage Index (SDI), representing disease activity and organ damage. We used the Beck Depression Inventory score (BDI), a validated screening instrument able to detect major depression and to estimate the prevalence of depression. A BDI score of more than 13 points was considered a high score. As a proxy for treatment of depression we assessed the number of patients using anti-depressants.
Results The mean BDI score was higher in SLE patients (n=102) compared to the BDI scores derived from a European population based study (ODIN study, n=7934), (10.1 points in patients with SLE vs 5.6 points in subjects from ODIN, p<0.001). This corresponds with a prevalence of depression of 16.6% in SLE patients vs 6.7% in the general population. Only 7% of the SLE patients with a high BDI score used anti-depressant medication.
There was no difference in disease characteristics, disease activity score (SLEDAI) and organ damage index (SDI) between SLE patients with and without depression (all p>0.1). The number of years of education was significantly lower in SLE patients with a depression compared to those without a depression (9.5 yrs. vs 12.2 yrs, p=0.004).
Conclusions The mean BDI score, i.e. a proxy for prevalence of depression, is almost doubled in SLE patients compared to the mean BDI score from a large pan European population based study. Surprisingly, we found no association between disease characteristics or severity of SLE and presence of depression, determined with the BDI.
Finally, we found that a small part of SLE patients with a high depression score were treated with anti-depressant medication, suggesting that depressed SLE patients might not be adequately recognized and treated for depression. For depressed SLE patients, this study provides clues that screening for depression in SLE patients should be done routinely, and that psychiatric counseling for these patients should be readily available.
Veerman JL, Dowrick C, Ayuso-Mateos JL, et al. Population prevalence of depression and mean Beck Depression Inventory score. Br J Psychiatry. 2009;195:516-9.
Disclosure of Interest None Declared