Depressive symptoms among patients with systemic lupus erythematosus in rheumatology clinic: associated factors and willingness to seek psychiatric help / Nur Adlina Tajul Arifin

Introduction: Long-standing chronic illnesses such as Systemic lupus erythematosus (SLE) patients are at high risk for depression due to non-resolving diseases that might affect the quality of patients' lives. This study aimed to establish the factors associated with depressive symptoms among patients with SLE and willingness to seek psychiatric help in the rheumatology clinic.
Method: A single-centre cross-sectional study among SLE patients. Patients were given WHO Quality of Life-BREF (WHOQOL-BREF) questionnaires and The Center for Epidemiological Studies–Depression Scale (CESD) to assess for quality of life (QoL) and depressive symptoms. Cumulative organ damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), total steroids in 3 months were recorded. Disease activity was measured using the British Isles Lupus Assessment Group's (BILAG 2004). The presence of fibromyalgia is also screened. CESD score ≥ 16 shows significant depressive symptoms. Univariate analysis is used to study the factors associated with depressive disorders and the impact of depressive symptoms in compliance and quality of life. All patients who had significant depressive symptoms were then referred to psychiatry.
Result: 165 patients with SLE participated in this study. Based on the CESD score, 57 (34.54%) patients scored ≥16, which indicated depressive symptoms, and 108 (65.45%) patients scored <16, which indicated no depressive symptoms. We discovered no significant association of depressive symptoms with sociodemographic data, prednisolone dosage, SDI and disease activities. However, the patient who had fibromyalgia in SLE showed substantial depressive symptoms with a p-value of 0.049. The study showed that patients with depression had a low quality of life (QoL) and missed medication. Out of 57 patients with depressive symptoms, 15 (26.3%) agreed for psychiatric evaluation, while 32 (56.14%) refused psychiatric evaluation.
Conclusion: one-third of our SLE patients had depressive symptoms associated with lower quality of life and poor compliance to treatment. A holistic approach to patient management would include identifying these patients to improve patients' outcomes. However, we did not find any factors associated with depressive symptoms to identify patients subjected to screening for depression. Another critical finding is patients' unwillingness to seek psychiatric help.