At least 1 out of 4 adults with systemic lupus erythematosus (SLE) may suffer from major depression or anxiety, according to a study published in BMC Psychiatry.

Psychological comorbidities are common with SLE, and data suggest that the prevalence of anxiety and depression is twice as high as that in the general population. Depression and anxiety contribute to increased morbidity and mortality in patients with SLE and are associated with cardiovascular disease, suicidal ideation, and physical disability. 

Treating depression and anxiety may help improve the quality of life in patients with SLE. However, the prevalence of these psychiatric disorders in SLE has not been clearly established, and estimates range from 2% to more than 90%.

Researchers sought to determine the prevalence of major depressive disorder and anxiety in adult patients with SLE in a systematic review. The analysis included data from 10,828 patients from 59 studies, which used 35 and 13 different definitions of depression and anxiety, respectively.

High-Yield Data Summary

  • Rheumatologists should screen for depression and anxiety in patients with systemic lupus erythematosus and refer them to mental health providers to identify effective strategies for treatment and prevention. 

The prevalence of major depression was 24% according to Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria, 30% according to the Hospital Anxiety and Depression Scale (HADS), and 39% according to the 21-Item Beck Depression Inventory.

The prevalence of anxiety was 40% according to the HADS and 37% according to DSM and ICD criteria.

“These prevalence estimates are significantly higher than those observed in the general population and other rheumatic and connective tissue diseases,” the researchers wrote. “Furthermore, these findings demonstrated that SLE patients tended to have a higher prevalence of anxiety than depression, which was in line with previous studies.”

Summary and Clinical Applicability

Patients with SLE are more likely to have depression or anxiety than the general population, although reported prevalence rates vary widely. Researchers conducted a meta-analysis of the available evidence and found that the prevalence of major depressive disorder ranged from 24% to 39% and the prevalence of anxiety was approximately 40%.

“The prevalence of depression and anxiety was high in adult SLE patients. It indicated that rheumatologists should screen for depression and anxiety in their patients, and they should refer them to mental health providers in order to identify effective strategies for preventing and treating depression and anxiety among SLE patients,” the researchers wrote.

Study Limitations 

  • The quality of studies included in the meta-analysis varied widely. 
  • The evidence on the prevalence of depression in SLE has 2 important shortcomings. (1) The heterogeneity among the studies in the review was not explained by the variables that were examined, and underexamined factors including gender, age, and disease duration may have contributed to depression and anxiety symptoms in patients with SLE. (2) Heterogeneity might result from the fact that reviewed studies in the analysis used different study designs and studied populations from different countries. 

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Reference

Zhang L, Fu T, Yin R, Zhang Q, Shen B. Prevalence of depression and anxiety in systemic lupus erythematosus: a systematic review and meta-analysis. BMC Psychiatry. 2017;17(1):70. doi:10.1186/s12888-017-1234-1

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