Background Psychiatric symptoms are common in patients with SLE. Most studies utilized self-rated scales of psychiatric symptoms for evaluation. Formal diagnosis of depression was not established by psychiatric interviews.
Objectives To determine the prevalence of depressive disorders, severity of depressive symptoms and the associated clinical and socioeconomic factors in Chinese patients with SLE.
Methods Patients who fulfilled ≥4 ACR criteria for SLE were randomly recruited from rheumatology out-patient clinics and hospital admission in a 9-month period. Psychiatric disorders were diagnosed by a direct interview with the psychiatrist using the Chinese-bilingual Structural Clinical Interview for DSM-IV Axis I disorders, patient research version (CB-SCID-I/P). The severity of depressive symptoms was assessed by the validated Chinese Hamilton Depressive Rating Scale (HAM-D). Patients were also asked to complete the Beck Depression Inventory (BDI), Medical Outcomes Study Social Support Survey (MOS-SSS-C) and the WHO Quality of Life Measure-Abbreviated Version (WHOQOL-BREF, BREF (HK)). SLE disease activity (SLEDAI), organ damage (SLICC/SDI) and socio-demographic were collected and correlated with the presence of psychiatric disorders. Logistic regression models were used to study the independent factors associated with depressive disorders and the severity of depressive symptoms.
Results 175 SLE patients were studied (95%women, age 39.2±12.4 years, SLE duration 10.3±6.7 years). 27 (15%) and 37 (21%) patients were diagnosed with a current depressive (52%major depressive disorder, 22%dysthymia) or anxiety (35%generalized anxiety, 14%panic, 14%phobia, 8%adjustment) disorders, respectively. Patients with depressive disorders, as compared to those without psychiatric disorders, had more active SLE (p=0.03) and were more likely to have a history of psychiatric diagnosis (p<0.001) and financial assistance from Government (p=0.04). Independent factors associated with a depressive disorder were SLEDAI score (1.13 [1.02–1.24];p=0.02), perceived poor social support (p=0.03) and a past history of psychiatric disorders (p=0.003). Age, disease duration and other socio-economic variables such as educational level and marriage status were not correlated with the presence of a depressive disorder. Being separated/divorced (β=0.19;p=0.02), having a higher SLEDAI score (β=0.16;p=0.02), SLE duration (β=-0.18;p=0.02) and a past history of psychiatric disorders (β=0.18;p=0.01) were independently associated with higher HAM-D scores, which reflect more severe depressive symptoms. Depressive disorders and severity of depressive symptoms were significantly associated with poorer quality of life. ROC analysis showed that a cut-off of 14 points of the self-rated BDI had a sensitivity of 89% and a specificity of 83% for differentiating a current depressive disorder from those without.
Conclusions A diagnosis of depressive disorders is prevalent in Chinese patients with SLE. Independent risk factors are more active disease, perceived poor social support and a past history of psychiatric disorders. Patients with more active SLE, shorter disease duration, a past history of psychiatric disorders and being separated were associated with more serious depressive symptoms. The self-rated BDI provides a good screening tool for identifying depressive disorders in SLE patients.
Disclosure of Interest None declared