Depressed Symptomatology in Systemic Lupus Erythematosus Patients

Objective: 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 and 2) what is the longitudinal relationship between SLE disease activity and depressed affect?. Methods: Longitudinal data from patients with American College of Rheumatology– or Systemic Lupus International Collaborating Clinics–classified SLE were analyzed. Depressed symptoms were assessed at each visit using the Center for Epidemiologic Studies Depression Scale, Revised (CESD-R), and SLE disease activity was measured via the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). Group-based trajectory modeling (GBTM) and linear mixed models were used for analysis. Results: The study sample (n = 144) was 56.3% Black and 38.9% White. GBTM revealed 5 distinct groups of patients who demonstrated consistent trends in depression over time. 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. Conclusions: The majority (61.2%) of patients had CESD-R scores consistent with persistent depressed affect or major depression over a period of up to 4 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.