J Rheum Dis.  2015 Dec;22(6):346-355. 10.4078/jrd.2015.22.6.346.

Depression and Quality of Life in Patients with Systemic Lupus Erythematosus

Affiliations
  • 1Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
  • 2Graduate School of Public Health, Seoul National University, Seoul, Korea.
  • 3Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. ysong@snu.ac.kr
  • 4Department of Internal Medicine, Seoul Medical Center, Seoul, Korea.
  • 5Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 6Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea.
  • 7Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Medical Research Center, Seoul National University, Seoul, Korea.

Abstract


OBJECTIVE
The objective of this study is to examine the prevalence of depression and its related factors including quality of life, brain-derived neurotrophic factor (BDNF), and vitamin D in patients with systemic lupus erythematosus (SLE).
METHODS
Depression was assessed using the center for epidemiologic studies depression (CES-D) scale. Disease activity, disease-related organ damage, the EuroQol-5 dimensions (EQ-5D), sociodemographic features, and laboratory tests including serum vitamin D level were surveyed. Serum BDNF was measured using an enzyme-linked immunosorbent assay.
RESULTS
Depression was observed in 22.8% of 180 SLE patients (n=41). Patients with marital status of single/divorced/separated/widowed, a higher patient global assessment (PGA) score, and extreme pain/discomfort showed significant association with depression. The EQ-5D index showed negative correlation with CES-D score (r=-0.56, p<0.05). In each EQ-5D dimension, depression showed significant association with moderate to severe problems in self-care and usual activities, and extreme pain/discomfort. Serum BDNF levels were not associated with depression (p=0.75) but associated with SLE disease activity index (SLEDAI; r=-0.21, p<0.05). Serum vitamin D levels were not associated with depression (p=0.60) but showed negative correlation with SLEDAI (r=-0.23, p<0.05) and mean glucocorticoid dose over the previous 3 months (r=-0.21, p<0.05) after adjustment for use of vitamin D supplement.
CONCLUSION
Depression was prevalent in patients with SLE and was associated with low quality of life, and a higher PGA but not with SLEDAI. Serum BDNF and vitamin D levels were not associated with depression but showed snegative correlation with SLEDAI.

Keyword

Systemic lupus erythematosus; Depression; Quality of life; Brain-derived neurotrophic factor; Vitamin D

MeSH Terms

Brain-Derived Neurotrophic Factor
Depression*
Enzyme-Linked Immunosorbent Assay
Epidemiologic Studies
Humans
Lupus Erythematosus, Systemic*
Marital Status
Prevalence
Quality of Life*
Self Care
Vitamin D
Brain-Derived Neurotrophic Factor
Vitamin D

Figure

  • Figure 1. Association between serum levels of brain-derived neurotrophic peptide (BDNF) and depression in the patients with systemic lupus erythematosus (SLE). The serum levels of BDNF were comparable between the healthy subjects and SLE patients with depression or without depression (A). When the patients were divided into active and inactive disease, no difference in serum BDNF levels was found between patients with depression and those without depression (B).


Reference

1. Chisholm D, Sanderson K, Ayuso-Mateos JL, Saxena S. Reducing the global burden of depression: population-level analysis of intervention cost-effectiveness in 14 world regions. Br J Psychiatry. 2004; 184:393–403.
2. Palagini L, Mosca M, Tani C, Gemignani A, Mauri M, Bombardieri S. Depression and systemic lupus erythematosus: a systematic review. Lupus. 2013; 22:409–16.
Article
3. Karol DE, Criscione-Schreiber LG, Lin M, Clowse ME. Depressive symptoms and associated factors in systemic lupus erythematosus. Psychosomatics. 2013; 54:443–50.
Article
4. Sehlo MG, Bahlas SM. Perceived illness stigma is associated with depression in female patients with systemic lupus erythematosus. J Psychosom Res. 2013; 74:248–51.
Article
5. Oh DH, Kim SA, Lee HY, Seo JY, Choi BY, Nam JH. Prevalence and correlates of depressive symptoms in Korean adults: results of a 2009 korean community health survey. J Korean Med Sci. 2013; 28:128–35.
Article
6. Julian LJ, Yelin E, Yazdany J, Panopalis P, Trupin L, Criswell LA, et al. Depression, medication adherence, and service utilization in systemic lupus erythematosus. Arthritis Rheum. 2009; 61:240–6.
Article
7. DeGiorgio LA, Konstantinov KN, Lee SC, Hardin JA, Volpe BT, Diamond B. A subset of lupus anti-DNA antibodies cross-reacts with the NR2 glutamate receptor in systemic lupus erythematosus. Nat Med. 2001; 7:1189–93.
Article
8. Miller AH, Maletic V, Raison CL. Inflammation and its dis-contents: the role of cytokines in the pathophysiology of major depression. Biol Psychiatry. 2009; 65:732–41.
Article
9. Choi ST, Kang JI, Park IH, Lee YW, Song JS, Park YB, et al. Subscale analysis of quality of life in patients with systemic lupus erythematosus: association with depression, fatigue, disease activity and damage. Clin Exp Rheumatol. 2012; 30:665–72.
10. Doria A, Rinaldi S, Ermani M, Salaffi F, Iaccarino L, Ghirardello A, et al. Health-related quality of life in Italian patients with systemic lupus erythematosus. II. Role of clinical, immunological and psychological determinants. Rheumatology (Oxford). 2004; 43:1580–6.
Article
11. Smolen JS, Strand V, Cardiel M, Edworthy S, Furst D, Gladman D, et al. Randomized clinical trials and longitudinal observational studies in systemic lupus erythematosus: consensus on a preliminary core set of outcome domains. J Rheumatol. 1999; 26:504–7.
12. Brunoni AR, Lopes M, Fregni F. A systematic review and meta-analysis of clinical studies on major depression and BDNF levels: implications for the role of neuroplasticity in depression. Int J Neuropsychopharmacol. 2008; 11:1169–80.
Article
13. Sen S, Duman R, Sanacora G. Serum brain-derived neurotrophic factor, depression, and antidepressant medications: meta-analyses and implications. Biol Psychiatry. 2008; 64:527–32.
Article
14. Anglin RE, Samaan Z, Walter SD, McDonald SD. Vitamin D deficiency and depression in adults: systematic review and meta-analysis. Br J Psychiatry. 2013; 202:100–7.
Article
15. Mozaffari-Khosravi H, Nabizade L, Yassini-Ardakani SM, Hadinedoushan H, Barzegar K. The effect of 2 different single injections of high dose of vitamin D on improving the depression in depressed patients with vitamin D deficiency: a randomized clinical trial. J Clin Psychopharmacol. 2013; 33:378–85.
16. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997; 40:1725.
Article
17. Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas. 1977; 1:385–401.
18. Cho MJ, Nam JJ, Suh GH. Prevalence of symptoms of depression in a nationwide sample of Korean adults. Psychiatry Res. 1998; 81:341–52.
Article
19. Julian LJ, Gregorich SE, Tonner C, Yazdany J, Trupin L, Criswell LA, et al. Using the Center for Epidemiologic Studies Depression Scale to screen for depression in systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2011; 63:884–90.
Article
20. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001; 33:337–43.
21. Kang EJ, Shin HS, Park HJ, Jo MW, Kim NY. A valuation of health status using EQ-5D. J Korean Health Econ Policy. 2006; 12:19–43.
22. Kim MH, Cho YS, Uhm WS, Kim S, Bae SC. Cross-cultural adaptation and validation of the Korean version of the EQ-5D in patients with rheumatic diseases. Qual Life Res. 2005; 14:1401–6.
Article
23. Tamura S, Suzuki H, Hirowatari Y, Hatase M, Nagasawa A, Matsuno K, et al. Release reaction of brain-derived neurotrophic factor (BDNF) through PAR1 activation and its two distinct pools in human platelets. Thromb Res. 2011; 128:e55–61.
Article
24. Nagahara AH, Tuszynski MH. Potential therapeutic uses of BDNF in neurological and psychiatric disorders. Nat Rev Drug Discov. 2011; 10:209–19.
Article
25. Krishnan V, Nestler EJ. The molecular neurobiology of depression. Nature. 2008; 455:894–902.
Article
26. Julian LJ, Tonner C, Yelin E, Yazdany J, Trupin L, Criswell LA, et al. Cardiovascular and disease-related predictors of depression in systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2011; 63:542–9.
Article
27. Moldovan I, Katsaros E, Carr FN, Cooray D, Torralba K, Shinada S, et al. The patient reported outcomes in lupus (PATROL) study: role of depression in health-related quality of life in a Southern California lupus cohort. Lupus. 2011; 20:1285–92.
Article
28. van Exel E, Jacobs J, Korswagen LA, Voskuyl AE, Stek M, Dekker J, et al. Depression in systemic lupus erythematosus, dependent on or independent of severity of disease. Lupus. 2013; 22:1462–9.
Article
29. Alarcón GS, McGwin G Jr, Brooks K, Roseman JM, Fessler BJ, Sanchez ML, et al. LUMINA Study Group. Lupus in minority populations: nature versus nurture. Systemic lupus erythematosus in three ethnic groups. XI. Sources of discrepancy in perception of disease activity: a comparison of physician and patient visual analog scale scores. Arthritis Rheum. 2002; 47:408–13.
30. Tamayo T, Fischer-Betz R, Beer S, Winkler-Rohlfing B, Schneider M. Factors influencing the health related quality of life in patients with systemic lupus erythematosus: long-term results (2001-2005) of patients in the German Lupus Erythematosus Self-Help Organization (LULA Study). Lupus. 2010; 19:1606–13.
Article
31. Avis NE, Levine B, Naughton MJ, Case LD, Naftalis E, Van Zee KJ. Age-related longitudinal changes in depressive symptoms following breast cancer diagnosis and treatment. Breast Cancer Res Treat. 2013; 139:199–206.
Article
32. Iannuccelli C, Spinelli FR, Guzzo MP, Priori R, Conti F, Ceccarelli F, et al. Fatigue and widespread pain in systemic lupus erythematosus and Sjögren's syndrome: symptoms of the inflammatory disease or associated fibromyalgia? Clin Exp Rheumatol. 2012; 30(6 Suppl 74):117–21.
33. Lin EH, Katon W, Von Korff M, Tang L, Williams JW Jr, Kroenke K, et al. IMPACT Investigators. Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial. JAMA. 2003; 290:2428–9.
34. Ikenouchi-Sugita A, Yoshimura R, Okamoto T, UmeneNakano W, Ueda N, Hori H, et al. Serum brain-derived neurotrophic factor levels as a novel biological marker for the activities of psychiatric symptoms in systemic lupus erythematosus. World J Biol Psychiatry. 2010; 11:121–8.
Article
35. Ikenouchi-Sugita A, Yoshimura R, Kishi T, UmeneNakano W, Hori H, Katsuki A, et al. No association between BDNF Val66Met polymorphism and emergence of psychiatric symptoms in systemic lupus erythematosus patients. Hum Psychopharmacol. 2011; 26:348–51.
Article
36. Yau SY, Lau BW, Zhang ED, Lee JC, Li A, Lee TM, et al. Effects of voluntary running on plasma levels of neuro-trophins, hippocampal cell proliferation and learning and memory in stressed rats. Neuroscience. 2012; 222:289–301.
Article
37. Fernandes de Abreu DA, Eyles D, Féron F. Vitamin D, a neu-ro-immunomodulator: implications for neurodegenerative and autoimmune diseases. Psychoneuroendocrinology. 2009; 34(Suppl 1):S265–77.
Article
38. Ritterhouse LL, Crowe SR, Niewold TB, Kamen DL, Macwana SR, Roberts VC, et al. Vitamin D deficiency is associated with an increased autoimmune response in healthy individuals and in patients with systemic lupus erythematosus. Ann Rheum Dis. 2011; 70:1569–74.
Article
39. Amital H, Szekanecz Z, Szücs G, Dankó K, Nagy E, Csépány T, et al. Serum concentrations of 25-OH vitamin D in patients with systemic lupus erythematosus (SLE) are inversely related to disease activity: is it time to routinely supplement patients with SLE with vitamin D? Ann Rheum Dis. 2010; 69:1155–7.
40. The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum. 1999; 42:599–608.
Full Text Links
  • JRD
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr