Having a chronic disease sucks. It's that simple. So it should come as no surprise that complex diseases like lupus lend themselves to anxiety and depression. Multiple abstracts reviewed this issue at ACR 2016 this year. For example, the longitudinal cohort GOAL (Georgians Organized Against Lupus) following SLE patients in Atlanta found that over half of African American patients with lupus had poor medication adherence and over 60% had depressive symptoms ranging from mild to severe (Abstract #1967).
Anther study from Temple University (Abstract #1766) showed that lupus patients with depression had significantly more flares than those without. Having depression was also a contributor to poor body image that is common among many lupus patients (Abstract #1767).
Zahi Touma and colleagues evaluated the prevalence of depression and anxiety in lupus by performing a systematic literature review. The final analysis of 121 articles found a pooled prevalence of depression of 35.2% (95% CI 30.1, 40.5) (70 studies, 23,399 patients) and anxiety of 24.2% (95% CI 17.9,31.2) (39 studies, 4495 patients). While this analysis also focused on the tools and metrics for depression, it underlined how important mental health is in our lupus patients.
Asking about depression and anxiety and helping our lupus patients receive the appropriate mental health support (e.g. psychiatry, psychology) appears to be very critical for these patients in the long-term. It reminds me of one young lupus patient I met who developed such severe anxiety that she could barely leave the house. She had to quit school and her job, and frequently missed health appointments. Fortunately, through local mental health supports including psychiatry and continued active lupus management, she improved considerably and is now back to her previously abandoned life. Whether we are asking simple questions in clinic about depression/anxiety or using validated depression scales, the dialogue needs to be opened to effect change.