Persistence of Depression and Anxiety despite Short-Term Disease Activity Improvement in Patients with Systemic Lupus Erythematosus: A Single-Centre, Prospective Study

Abstract

Mental disorders such as anxiety and depression are prevalent in systemic lupus erythematosus (SLE) patients, yet their association with the underlying disease activity remains uncertain and has been mostly evaluated at a cross-sectional level. To examine longitudinal trends in anxiety, depression, and lupus activity, a prospective observational study was performed on 40 adult SLE outpatients with active disease (SLE Disease Activity Index [SLEDAI]-2K ≥ 3 [excluding serology]) who received standard-of-care. Anxiety and depression were determined at baseline and 6 months by the Hospital Anxiety and Depression Scale. Treatment adherence was assessed with the Morisky Medication Adherence Scale-4. Increased anxiety (median [interquartile range] HADS-A: 11.0 [7.8]) and depression (HADS-D: 8.0 [4.8]) were found at inclusion, which remained stable and non-improving during follow-up (difference: 0.0 [4.8] and −0.5 [4.0], respectively) despite reduced SLEDAI-2K by 2.0 (4.0) (p < 0.001). Among possible baseline predictors, paid employment—but not disease activity—correlated with reduced HADS-A and HADS-D with corresponding standardized beta-coefficients of −0.35 (p = 0.017) and −0.27 (p = 0.093). Higher anxiety and depression correlated with lower treatment adherence (p = 0.041 and p = 0.088, respectively). These results indicate a high-mental disease burden in active SLE that persists despite disease control and emphasize the need to consider socioeconomic factors as part of comprehensive patient assessment.

Keywords: comorbidities; compliance; low-disease activity; mood disorders; patient outcome.

Figure 1

Longitudinal changes in anxiety and depression in association with improvement or not in disease activity. (A) Dot plots demonstrate changes (follow-up minus baseline) in HADS-A (left panel) and HADS-D (right panel) in SLE patients with improving vs. stable or worsening disease activity (SLEDAI-2K). Independent samples Mann–Whitney test was performed between the two patient groups. Blue lines represent medians (interquartile range). (B) Correlation of longitudinal changes (follow-up minus baseline) in HADS-A (Δ HADS-A) and HADS-D (Δ HADS-D) values in the SLE sample (each patient is represented by a separate black circles). The Spearman’s correlation coefficient rho = 0.457 (p-Value = 0.003).