In African-American women with systemic lupus erythematosus (SLE), organ damage was positively correlated with depression, while social support offered protection against depression. However, social support was not found to be a moderating factor in the damage-depression interaction, according to study findings published in Lupus.
Although African-American women are disproportionately affected by SLE, research on this population remains scarce. Investigators sought to examine the relationship between organ damage and depression in African-American women with SLE and determine how social support affects this relationship.
A mixed-methods cross-sectional approach utilized self-reported quantitative survey data and qualitative interview responses from African-American women enrolled in the 2013 Georgians Organized Against Lupus (GOAL) study. A total of 437 (mean age, 48.28) African-American women completed both the Patient Health Questionnaire (PHQ-9) to assess depression and the Brief Index of Lupus Damage (BILD) to evaluate organ damage. Participants also answered questions regarding social support frequency. At a later date, 15 GOAL participants were also interviewed about the role support plays in their lives.
The mean scores on the PHQ-9 and BILD were 8.3 and 2.5, respectively. Organ damage was positively correlated with depression (r = 0.163; P =.001) while social support was negatively correlated with depression (P <.001). After multiple regression analysis, organ damage predicted depression (P =.018) and social support was protective against it (P <.001). However, social support was not a significant moderator of the damage-depression association (P =.189).
Interviews revealed that nearly all participants had experienced depression following SLE diagnosis. Patients considered many aspects of social support important to their care and well-being, including comprehension of the disease by friends and family and having adequate support from friends and family, physicians, and faith or support groups. Responses varied among patients in terms of support levels and whether these levels were affected by having SLE. In general, researchers found that women requiring the most support were women who had the most extensive organ damage.
Study strengths included the mixed methodology using multiple sources, specific targeting of African-American women, comfortable and convenient interview sites, large sample size, and the utilization of validated measures.
Study limitations included a cross-sectional design that prevented causal analysis, measuring depressive symptoms rather than actual diagnoses, the use of an ad hoc question to ascertain support status, and the lack of generalizability to other SLE populations.
“Overall, these findings highlight the importance of monitoring depressive symptoms in this population and developing interventions aimed to increase social support available to lupus patients,” concluded the authors. They recommended that future research continue to investigate the relationship between support and depression, as well as explore other patient needs.
Jordan J, Thompson N, Dunlop-Thomas C, Lim SS, Drenkard C. Relationships among organ damage, social support, and depression in African American women with systemic lupus erythematosus [published online November 27, 2018]. Lupus. doi:10.1177/0961203318815573