Background The development of depressive symptoms is very common among patients with Systemic Sclerosis (SSc).1
Objectives Evaluation of the prevalence of depressive symptoms among German SSc patients at our centre, identification of possible risk factors and analysis of the current standard of care in clinical settings.
Methods 94 of 134 patients (82 women (87.2%), age 58.3 ± 13.6 years, BMI 24.5 ± 5.4 kg/m2) in our study met the inclusion criteria of matching the ACR/EULAR 2013 classification criteria, being at least 18 years old, able to consent and having completed the Major Depression Inventory (MDI), Short Form 36 (SF-36®), Scleroderma Health Assessment Questionnaire (SHAQ), Brief Fatigue Inventory (BFI) and Physical Activity Questionnaire (IPAQ). The prevalence of depressive symptoms was evaluated using the MDI. The identifying potential of patient questionnaires for the risk of an SSc patient to suffer from depressive symptoms was evaluated using the SF-36® for quality of life, the SHAQ for disability, the BFI for fatigue and the IPAQ for activity. Discharge letters of the time when the patients were included were analyzed regarding the assessment and treatment of depressive symptoms and mental health. Clinical and para clinical parameters were measured according to standardized procedures. The data were analyzed with IBM SPSS® Statistics by using Chi-Square/Fisher-, Mann-Whitney-U-test, correlation and regression analysis.
Results The prevalence of depressive symptoms according to the MDI score ≥20 was 22.3%. In the analysis of risk factors between two subgroups (MDI Score <20 and MDI Score ≥20), underweight (BMI <18.5 kg/m2) turned out to be a significant risk factor (p=0.002) (Image 1). Also, there was a significant correlation between general health (SHAQ) (r=0.508, p=0.01), quality of life (SF 36®) (r= -0.769, p=0.01), fatigue (BFI) (r=0.721, p=0.01) and physical activity (IPAQ MET/min) (r= -0.331, p=0.01) with the level of the MDI score. The analysis of the current standard of care showed that the majority of the patients 84 (89.4%) were not assessed for depressive symptoms or mental health, including 19 with an MDI score ≥20. Mood disorders were diagnosed in 5 (5.3%) patients, 13 (13.8%) were treated with antidepressants and in 6 (6.4%) cases psychological intervention was carried out or suggested.
Conclusions There is a high prevalence of depressive symptoms, which should be kept in mind when treating patients with SSc. Special attention should be paid to weight loss and fatigue, results in the SF-36®, SHAQ and IPAQ. The mental health should be assessed during consultations on a regular basis. The questionnaires applied in this study could be used as indicators for the risk of an SSc patient to suffer from depressive symptoms with the BFI and SF-36 being the most sensitive ones.
Launay D, Baubet T, Cottencin O, Bérezné A, Zéphir H, Morell-Dubois S et.al., Atteintes neuropsychiatriques au cours de la sclérodermie systémique. La presse Médicale, 2010; 39:5
Disclosure of Interest None declared