Depression is a prevalent (24-30%) and significant comorbidity in patients with systemic lupus erythematosus (SLE). In the present study, we leveraged the longitudinal SLE cohort at the Washington University Lupus Clinic to address: 1) what is the longitudinal course of depressed affect among outpatients with SLE? 2) what is the longitudinal relationship between SLE disease activity and depressed affect?
Longitudinal data from patients with ACR or Systemic Lupus International Collaborating Clinics (SLICC)-classified SLE were analyzed. Depressed symptoms were assessed at each visit using the Center for Epidemiologic Studies Depression Scale, Revised (CESD-R) while SLE disease activity was measured via the SLEDAI2K Responder Index-50 (S2K RI-50). Group-based trajectory modeling (GBTM) and linear mixed models were used for analysis.
The sample (n=144) was 56.3% Black, and 38.9% White. GBTM revealed five distinct groups of patients who demonstrated consistent trends in depression overtime. Members of groups 4 (n=44, 30.6%) and 5 (n=44, 30.6%) demonstrated CESD-R scores consistent with depression. Of note, Black patients were much more common in Group 5 (n=32, 72.7%, p<0.02). Analyses identified an association between SLEDAI disease activity and depression scores in multivariate analysis but did not show significance in GBTM and univariate analysis.
The majority (61.2%) of patients had CESD-R scores consistent with persistent depressed affect or major depression over a period of up to four years. The lack of a consistent relationship of CESD-R with SLE disease activity highlights the need to regularly monitor, treat and better understand the causes behind this comorbidity. This article is protected by copyright. All rights reserved.