Objectives To study the effect of depressive/anxiety symptoms on quality of life and work disability in Chinese patients with systemic lupus erythematosus (SLE).
Methods Consecutive patients who fulfilled ≥4 ACR criteria for SLE were recruited. Depressive and anxiety symptoms were assessed by the Hospital Anxiety and Depression (HAD) scale (0-21 points). Health-related quality of life (HRQoL) was assessed by the validated Chinese version of MOS-Short Form (SF)-36 (mental component [MCS] and physical component [PCS]). Disease activity of SLE was assessed by SLEDAI and physicians' global assessment (PGA), whereas organ damage since SLE diagnosis was assessed by the ACR/SLICC damage index (SDI). The effect of depressive/anxiety symptoms on HRQoL was studied by linear regression, with adjustment for confounding covariates that included age, sex, disease activity, organ damage and psychosocial factors such as marital status, educational level, employment status and income.
Results 367 SLE patients were studied (95% women; age 40.2±12.9 years; disease duration 9.3±7.2 years). 67 (18%) patients had clinically active SLE (SLEDAI ≥5) and 137 (37%) patients had organ damage (SDI ≥1). 50 (14%) patients had HADS-depression score of ≥10 and 70 (19%) of patients had HADS-anxiety score of ≥10. Patients with depressive score of ≥10 had significantly lower PCS (28.8±18.1 vs 60.5±20.3; p<0.001) and MCS (25.2±15.6 vs 61.9±19.1; p<0.001) of the SF36 than those with score <10. Similarly, significant lower PCS (32.3±18.5 vs 61.4±20.1; p<0.001) and MCS (28.2±15.1 vs 63.4±18.6; p<0.001) were noted in those patients with HAD-anxiety score ≥10 compared to those <10. Excluding retirees, housewives, students and those unemployed within 12 months prior to study, 190 patients were evaluated for work disability. Thirty patients (16%) who were working in 12 months prior to this study quitted their job (N=22) or reduced working hours (N=8) at the time of study entry. The mean daily working hours reduced from 6.4±2.5 to 1.2±2.3 in these patients. The commonest self-reported reasons for reducing/quitting work were joint/muscle aches (47%), fatigue (20%), anxiety/depressive symptoms (17%) and skin lesions causing cosmetic problem (7%). Patients with work disability had significantly higher HAD-depression score than those without (6.31±5.51 vs 3.93±3.72; p=0.03). Other parameters such as age, sex, SLE duration, HAD-anxiety score, mean SLEDAI in the preceding 12 months, total SDI damage score and SF36 score were not significantly different between patients with and without work disability. Linear regression analysis revealed that in all the patients studied, both the MCS and PCS of SF36 score was significantly associated with HAD-depression score (Beta -0.75, p<0.001 and Beta -0.64, p<0.001, respectively) after adjustment for age, sex, SLE duration, years of education, religious belief, marital status, employment, poverty (dependence of government financial subsidy), total SDI damage score and mean SLEDAI in the preceding 12 months.
Conclusions Depressive and anxiety symptoms were common in SLE patients and were associated with significantly poorer HRQoL. Patients with depressive symptoms were more likely to have their job quitted or working hours reduced.
Disclosure of Interest None declared