Major depression affects nearly 50% of young adults with systemic lupus erythematosus (SLE), and the risk is highest in young adults with childhood-onset SLE. Risk factors for depression include poorer physical functioning, increased disease activity, and lower educational attainment. These study results were published in Arthritis Care & Research.
Depression affects up to 60% of adults with SLE — with the highest rates in young adults. Approximately 1 of 5 patients with SLE has disease onset during childhood, and experience higher rates of depression than their adolescent peers (20% vs 13%). In the general population, depressive symptoms during adolescence predict major depression and suicide in adulthood. However, data are lacking regarding the risk for developing depression in adulthood in patients with childhood-onset SLE.
Researchers, led by Erica Lawson, MD, from University of California, San Francisco (UCSF) Benioff Children’s Hospital, and Andrea Knight, MD, MSCE, from the Children’s Hospital of Philadelphia, Pennsylvania sought to determine the risk factors and long-term risk for depression in patients with childhood-onset SLE.
Data were obtained from 546 young adult (age 18 to 45) participants with SLE in a prospective longitudinal cohort known as the Lupus Outcomes Study. Of these, 115 (21%) had childhood-onset SLE. Yearly telephone surveys were conducted in this cohort over a period of 12 years.
The prevalence of major depression was 47%, and the risk for depression was significantly higher in patients with childhood-onset SLE than in patients with adult-onset SLE (odds ratio [OR], 1.7).
Predictors of depression included a history of smoking (adjusted OR [aOR], 1.3), lower physical function (aOR, 1.03), and higher disease activity (aOR, 1.11). Depression risk increased with lower levels of education completed; patients who did not complete high school were at highest risk compared with patients with a bachelor’s or postgraduate degree (aOR, 2.5).
Summary and Clinical Applicability
Major depression is prevalent in children and adults with SLE. Until recently, the risk factors and long-term risk for depression in adulthood were unknown in patients with childhood-onset SLE. Researchers found that childhood-onset SLE, increased disease activity, poorer physical functioning, and lower education attainment were major predictors for depression in adulthood.
“Patients with SLE have a high prevalence of depression, up to 60%, but those with childhood-onset disease may be particularly susceptible. It’s very important for these patients’ quality of life that we’re not just looking at their lab values, but we’re also asking about how they’re functioning and providing referrals to mental health care when it’s indicated,” Dr Lawson said in an interview with Rheumatology Advisor.
Limitations and Disclosures
According to Dr Lawson, an important limitation of this study is that participants with childhood-onset SLE had lower disease activity and better physical function than participants with adult-onset SLE. “There appears to be a degree of survivorship bias, where the participants with childhood-onset lupus are actually healthier than participants with adult-onset lupus. So if you take all comers, it may be that young adults with childhood-onset lupus are at even greater risk for depression than reflected in our study,” she said.
Dr Lawson reports no relevant disclosures.
Knight AM, Trupin L, Katz P, Yelin E, Lawson EF. Depression risk in young adults with childhood- and adult-onset lupus: 12 years of follow-up [published online May 23, 2017]. Arthritis Care Res (Hoboken). doi:10.1002/acr.23290