Depression and anxiety in systemic lupus erythematosus: The crosstalk between immunological, clinical, and psychosocial factors

Abstract

Depression and anxiety cause severe loss of quality of life for patients with systemic lupus erythematosus. The causes and factors that contribute to these psychological manifestations in lupus are difficult to disentangle. This study compared clinical, psychological, and demographic factors between lupus patients, depressed patients, and rheumatoid arthritis patients to discover lupus-specific contributors to depression. Lupus-specific manifestations of depression were also investigated.Physiological, clinical, and psychosocial data were collected from 77 patients. ELISA was used to measure cytokine levels. Univariate and Multivariate analyses were used to compare the patient populations and identify correlations between key physical and psychological indicators.The prevalence of depression in the SLE cohort was 6 times greater than the healthy control subjects. Pain, IL-6, and Pittsburgh Sleep Quality index values were all significantly higher in SLE patients compared with the healthy control group (P < .001, P = .038, and P = .005, respectively). Anxiety levels were significantly higher in SLE patients compared to healthy and RA control patients (P = .020 and .011, respectively). Serum IL-10 concentrations, relationship assessment scale, and fatigue severity scale values were found to be correlated with depression among the SLE patients (P = .036, P = .007, and P = .001, respectively). Relationship assessment and fatigue severity scale scores were found to be the best indicators of depression for the SLE patients (P = .042 and .028, respectively).Fatigue Severity, relationship satisfaction, and IL-10 concentrations are indicators of depression in lupus patients. Despite also suffering from the pain and disability that accompanies chronic autoimmune disease, the rheumatoid arthritis patients had less anxiety and better relationship scores.

Figure 1

Cytokine serum concentrations differ between cohort subgroups. SLE IL-6 and IL-10 serum concentrations are statistically higher than healthy subjects. RA patients demonstrate slightly higher average serum levels of pro-inflammatory cytokines IL-6 and TNF-α. Depressed and SLE patients demonstrate slightly higher concentrations of IL-10 on average than other cohort subjects. IL = interleukin, RA = rheumatoid arthritis, SLE = systemic lupus erythematosus, TNF = tumor necrosis factor.

Figure 2

Linear regression identifies clinical and psychological assessments that are correlated with depression in SLE patients. Univariate analysis found IL-10, relationship assessment scale, and fatigue severity scale values to be correlated with depression in our SLE cohort. IL-10 and relationship satisfaction are negatively correlated with depression, while fatigue severity is positively correlated.