Depressed Symptomatology Persists Over Time 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?. 2) what is the longitudinal relationship between SLE disease activity and depressed affect?. Methods: 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. Results: 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. 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 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.