Correlation between physical markers and psychiatric health in a Portuguese systemic lupus erythematosus cohort: The role of suffering in chronic autoimmune disease

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Abstract

Background

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects a large number of people throughout the world. Anxiety, depression and fatigue are common symptoms of SLE that substantially contribute to decreased quality of life. This study investigates the interplay between physical and psychiatric manifestations of lupus. To this end, an SLE patient cohort was examined for correlations between clinical presentation, laboratory tests, and psychological indicators.

Methods

Seventy-two lupus patients were evaluated for psychological status using a battery of instruments, including assessments for fatigue (CFS & FSS), depression (HADS), anxiety (HADS), overall health (SF-36 & PSQI) and intimate relationship satisfaction (RAS & CSI). Scores from these assessments were correlated with lupus clinical profiles and laboratory test values.

Results

The prevalence of depression in the SLE patient cohort was 41.7%, as measured by the hospital depression and anxiety scale. The study identified that pain (p = 0.001), body mass index (p = 0.026), Chalder’s fatigue scale (p < 0.001), fatigue severity scale (p < 0.001), and anxiety (p = 0.001) are all positively correlated with depression in SLE patients. Total complement (CH50) (p = 0.032), and SF-36 physical and mental characteristic assessments are negatively correlated with depression. Longitudinal analysis indicated that the disease related complaint alopecia (p = 0.008) and relationship assessment scale scores (p = 0.004) may also be correlated to depression in SLE patients. Multivariant scrutiny of the clinical and psychosocial characteristics identified the fatigue severity scale (p = 0.026), SF-36 physical function (p = 0.040), physical role function (0.030), and mental health (p = 0.002) as the best indicators directly correlated with depression for the SLE cohort.

Conclusion

These results reveal the influence of physical manifestations of lupus including fatigue, pain, body mass index and anxiety, as well as decreased physical and mental function, on depression. Fatigue is the strongest factor correlated with depression in SLE patients in the cohort. Both physical and social/psychological aspects likely contribute to the depression and anxiety in lupus.

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Most cited references 38

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Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial.

Elizabeth Lin, Wayne J Katon, Michael Von Korff … (2003)

Depression and arthritis are disabling and common health problems in late life. Depression is also a risk factor for poor health outcomes among arthritis patients. To determine whether enhancing care for depression improves pain and functional outcomes in older adults with depression and arthritis. Preplanned subgroup analyses of Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), a randomized controlled trial of 1801 depressed older adults (> or =60 years), which was performed at 18 primary care clinics from 8 health care organizations in 5 states across the United States from July 1999 to August 2001. A total of 1001 (56%) reported coexisting arthritis at baseline. Antidepressant medications and/or 6 to 8 sessions of psychotherapy (Problem-Solving Treatment in Primary Care). Depression, pain intensity (scale of 0 to 10), interference with daily activities due to arthritis (scale of 0 to 10), general health status, and overall quality-of-life outcomes assessed at baseline, 3, 6, and 12 months. In addition to reduction in depressive symptoms, the intervention group compared with the usual care group at 12 months had lower mean (SE) scores for pain intensity (5.62 [0.16] vs 6.15 [0.16]; between-group difference, -0.53; 95% confidence interval [CI], -0.92 to -0.14; P =.009), interference with daily activities due to arthritis (4.40 [0.18] vs 4.99 [0.17]; between-group difference, -0.59; 95% CI, -1.00 to -0.19; P =.004), and interference with daily activities due to pain (2.92 [0.07] vs 3.17 [0.07]; between-group difference, -0.26; 95% CI, -0.41 to -0.10; P =.002). Overall health and quality of life were also enhanced among intervention patients relative to control patients at 12 months. In a large and diverse population of older adults with arthritis (mostly osteoarthritis) and comorbid depression, benefits of improved depression care extended beyond reduced depressive symptoms and included decreased pain as well as improved functional status and quality of life.

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Prevalence of depression and anxiety in systemic lupus erythematosus: a systematic review and meta-analysis

Lijuan Zhang, Ting-ming Fu, Rulan Yin … (2017)

Background Systemic lupus erythematosus (SLE) patients are at high risk for depression and anxiety. However, the estimated prevalence of these disorders varies substantially between studies. This systematic review aimed to establish pooled prevalence levels of depression and anxiety among adult SLE patients. Methods We systematically reviewed databases including PubMed, Embase, PsycINFO, and the Cochrane database library from their inception to August 2016. Studies presenting data on depression and/or anxiety in adult SLE patients and having a sample size of at least 60 patients were included. A random-effect meta-analysis was conducted on all eligible data. Results A total of 59 identified studies matched the inclusion criteria, reporting on a total of 10828 adult SLE patients. Thirty five and thirteen methods of defining depression and anxiety were reported, respectively. Meta-analyses revealed that the prevalence of major depression and anxiety were 24% (95% CI, 16%-31%, I2 = 95.2%) and 37% (95% CI, 12%–63%, I2 = 98.3%) according to clinical interviews. Prevalence estimates of depression were 30% (95% CI, 22%–38%, I2 = 91.6%) for the Hospital Anxiety and Depression Scale with thresholds of 8 and 39% (95% CI, 29%–49%, I2 = 88.2%) for the 21-Item Beck Depression Inventory with thresholds of 14, respectively. The main influence on depression prevalence was the publication years of the studies. In addition, the corresponding pooled prevalence was 40% (95% CI, 30%–49%, I2 = 93.0%) for anxiety according to the Hospital Anxiety and Depression Scale with a cutoff of 8 or more. Conclusions 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 referred them to mental health providers in order to identify effective strategies for preventing and treating depression and anxiety among adult SLE patients. Trial registration Current Meta-analysis PROSPERO Registration Number: CRD 42016044125. Registered 4 August 2016. Electronic supplementary material The online version of this article (doi:10.1186/s12888-017-1234-1) contains supplementary material, which is available to authorized users.

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Comparability of telephone and face-to-face interviews in assessing axis I and II disorders.

P Lewinsohn, Corrine J. Seeley, Peter P. Rohde (1997)

The present study examined the comparability of data obtained by telephone and face-to-face interviews for diagnosing axis I and II disorders. Sixty young adults from the community were interviewed face-to-face and over the telephone regarding axis I disorders; another 60 subjects were interviewed twice regarding axis II disorders. The order of interviews was counterbalanced, and subjects with a history of disorder were oversampled. Agreement between telephone and face-to-face interviews was contrasted with interrater values, which were obtained by having a second interviewer rate a recording of the original interview. Interrater reliability was excellent. Agreement between telephone and face-to-face assessment was excellent for anxiety disorders and very good for major depressive disorder and alcohol and substance use disorders; agreement was problematic, however, for adjustment disorder with depressed mood. Strong support was shown for the validity of the axis II telephone assessment format. Small but consistent trends were noted for lower rates of psychopathology reported in the second interview. This is the first study in which telephone and face-to-face assessments of axis I and II psychopathology were conducted with the same subjects assigned to conditions in a counterbalanced manner. The present findings provide qualified justification for the use of telephone interviews to collect axis I and II data. The apparent concerns do not appear sufficient to override the economic and logistic advantages of telephone interviewing.

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Author and article information

Contributors

Margarida Figueiredo-Braga: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – review & editing

Caleb Cornaby: Role: Formal analysisRole: VisualizationRole: Writing – original draft

Miguel Bernardes: Role: InvestigationRole: Project administrationRole: Resources

Marta Figueiredo: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Investigation

Cristina Dos Santos Mesquita: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Investigation

Lúcia Costa: Role: Data curationRole: Investigation

Brian D. Poole:

ORCID: http://orcid.org/0000-0002-3205-640X

Role: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing

Jerson Laks: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 16 April 2018

Publication date Collection: 2018

Volume: 13

Issue: 4

Electronic Location Identifier: e0195579

Affiliations

[1 ] Medical Psychology Unit, Dep. Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal

[2 ] I3S Instituto de Investigação e Inovação em Saúde, Porto, Portugal

[3 ] Department of Microbiology and Molecular Biology, Brigham Young University, Provo, Utah, United States of America

[4 ] Rheumatology Department, Hospital of São João EPE, Porto, Portugal

[5 ] Departamento de Psicologia Aplicada (DPA), Universidade do Minho, Minho, Portugal

Universidade Federal do Rio de Janeiro, BRAZIL

Author notes

Competing Interests: The authors declare that no competing interests exist.

* E-mail: bpoole@ 123456gmail.com

Author information

Brian D. Poole http://orcid.org/0000-0002-3205-640X

Article

Publisher ID: PONE-D-17-33715

DOI: 10.1371/journal.pone.0195579

PMC ID: 5901990

PubMed ID: 29659589

SO-VID: afbb2fae-bd18-449b-a4b4-f11b16918610

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 15 September 2017

Date accepted : 26 March 2018

Page count

Figures: 2, Tables: 5, Pages: 16

Funding

Funded by: Fulbright commision Portugal

Award ID: Fulbright Grant

Award Recipient :

ORCID: http://orcid.org/0000-0002-3205-640X

Brian D. Poole

BDP was funded by the Fulbright commission: Portugal, scholar program. Funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Data Availability All relevant data are within the paper and its Supporting information files.

Correlation between physical markers and psychiatric health in a Portuguese systemic lupus erythematosus cohort: The role of suffering in chronic autoimmune disease

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Most cited references 38

Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial.

Prevalence of depression and anxiety in systemic lupus erythematosus: a systematic review and meta-analysis

Comparability of telephone and face-to-face interviews in assessing axis I and II disorders.

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