RCT: Mind-Body Training Improves Depressive Symptoms in SLE

WASHINGTON, DC — A randomized controlled trial found that both Mind-Body Skills Training (MBST) and Supportive Counseling/Symptom Monitoring (SCSM) improved depressive symptoms in study participants with systemic lupus erythematosus (SLE) and comorbid depression, according to data presented at the 2016 ACR/ARHP Annual Meeting, November 11-16, 2016 in Washington, DC.

“Although depressive symptoms are prevalent in persons with SLE, no studies to date have evaluated psychotherapy approaches in persons with SLE who also have comorbid depression,” wrote Carol Greco, PhD, from the University of Pittsburgh in Pittsburgh, Pennsylvania, and colleagues.

The researchers randomly assigned 90 participants with SLE and comorbid depression (mean age 49 years,92% women, and 23% African American or non-white) to receive either MBST (n = 45) or SCSM (n = 45). The training was conducted in 8 weekly individual sessions and 3 monthly “booster” sessions.

SLE was defined by the 1997 American College of Rheumatology (ACR) criteria.  Depression was defined by the Quick Inventory of Depressive Symtomatology-clinican interview version (QIDS-C) diagnostic criteria, as well as a score of greater than or equal to 16 on the Center for Epidemiology Studies Depression (CESD) scale.

MBST included mindfulness meditation methods and principals, as well as elements of cognitive-behavioral therapy (CBT). SCSM resembled traditional counseling, but with particular focus on topics particularly applicable to those with SLE, such as living with chronic illness and communication with family and healthcare providers. Both interventions included information on SLE, depression, and goal-setting.

The participants completed study evaluations and reported on mental health outcomes at baseline, mid-way through treatment, at the end of intervention, and at 6 and 12 month follow-up.

Of the 90 participants enrolled, 81% (n = 73) completed the study. At baseline, depressive symptoms were not different between the groups, and ranged from moderate to severe (MBST CESD = 29.7 +/- 6.4, SCSM CESD = 30 +/- 6; MBST QIDS = 12 +/- 3.4, SCSM QIDS = 11.6 +/- 3).

Both the MBST and SCSM groups self-reported improvements in depressive symptoms [time effect F (4,286)=44, P <.001], with a marginally significant group x time effect in favor of SCSM [F(4,286)=2, P =.07]. Both groups also improved on QIDS [time effect F(4,284) = 78, P <.001] without a significant group x time effect.

At 12 months, CESD scores averaged 21.3 (SD=8) for MBST and 20.2 (SD=6.5) for SCSM. This indicates that “despite improvement, participants continued to report some symptoms consistent with depression and/or chronic illness.” However, at 12 months, the QIDS scores averaged 5.5 (SD=4.6) for MBST and 3.6 (SD=2.6) for SCSM, which ranges from mild to no depression.

“Clinical diagnostic interviews indicated ‘no depression’ to ‘mild’ levels of depression at follow-up, whereas participants continued to self-report symptoms at follow-up, perhaps due to overlap between SLE and depressive symptoms such as lack of energy and difficulty concentrating,” the researchers noted. Ultimately, “psychotherapy approaches tailored to SLE may benefit many SLE patients who experience comorbid depression.”

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Reference

Greco C, Chen L-W, Cheng Y, McFarland C, Manzi S. Mind-body skills training and supportive counseling for depression in SLE: positive effects in a randomized controlled trial. Presented at: 2016 ACR/ARHP Annual Meeting. November 11-16, 2016; Washington, DC. Abstract 1056.