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Rheumatology International

, Volume 32, Issue 5, pp 1179–1187 | Cite as

Prevalence of depression and depressive symptoms in patients with systemic lupus erythematosus: Iranian experience

  • Zahra Zakeri
  • Mansoor Shakiba
  • Behzad NarouieEmail author
  • Nikol Mladkova
  • Mohammad Ghasemi-Rad
  • Alireza Khosravi
Original Article

Abstract

Psychiatric disorders including depression represent clinical manifestation of systemic lupus erythematosus (SLE). Recognition of depression in SLE patients is of utmost importance since it is treatable and can be of fatal consequences if unrecognized. This study was conducted to determine the prevalence of depression and depressive symptoms in SLE patients in terms of age, gender, disease duration and severity, and duration of steroid treatment in SLE patients. Eighty-five SLE patients (77 women, 8 men) with verified SLE diagnosis completed Beck’s depression inventory, a self-reported measure of depression. Clinical data on disease and treatment were obtained from patient files. In total, 60% of patients achieved scores indicating depression. The most common depressive symptoms in participants were fatigue and weakness (88.2%), irritability (82.3%), sadness (77.6%), and somatic preoccupation (76.4%), while the least common symptoms were weight loss (34.1%), low level of energy (28.2%), and suicide ideation (10.5%). There was a significant difference between the disease activity and the severity of depression (P = 0.0001). Our findings show higher prevalence of depression in our sample in comparison with previous studies, suggesting that the prevalence of depression varies across different populations. Severity of depression increases with more severe disease course.

Keywords

Systemic lupus erythematosus Depressive symptoms Depression Becks depression inventory 

References

  1. 1.
    Bachen EA, Chesney MA, Criswell LA (2009) Prevalence of mood and anxiety disorders in women with systemic lupus erythematosus. Arthritis Care Res 61(6):822–829CrossRefGoogle Scholar
  2. 2.
    Nery FG, Borba EF, Viana VST, Hatch JP, Soares JC, Bonfá E et al (2008) Prevalence of depressive and anxiety disorders in systemic lupus erythematosus and their association with anti-ribosomal P antibodies. Prog Neuropsychopharmacol Biol Psychiatry 32(3):695–700. doi: 10.1016/j.pnpbp.2007.11.014 PubMedCrossRefGoogle Scholar
  3. 3.
    Isenberg D (2004) Oxford textbook of rheumatology, 3rd edn. Oxford University Press, OxfordGoogle Scholar
  4. 4.
    Sadock BJ, Sadock VA (2000) Kaplan & Sadock’s comprehensive textbook of psychiatry, 7th edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  5. 5.
    Kelley WN (1997) Textbook of rheumatology, 5th edn. W.B. Saunders, PhiladelphiaGoogle Scholar
  6. 6.
    Purandare KN, Wagle AC, Parker SR (1999) Psychiatric morbidity in patients with systemic lupus erythematosus. QJM 92(5):283–286PubMedCrossRefGoogle Scholar
  7. 7.
    Kasper DL, Harrison TR (2005) Harrison’s principles of internal medicine, 16th edn. Medical Pub. Division, McGraw-HillGoogle Scholar
  8. 8.
    Julian LJ, Yelin E, Yazdany J, Panopalis P, Trupin L, Criswell LA et al (2009) Depression, medication adherence, and service utilization in systemic lupus erythematosus. Arthritis Rheum 61(2):240–246PubMedCrossRefGoogle Scholar
  9. 9.
    Chapel H (2006) Essentials of clinical immunology, 5th edn. Blackwell, MaldenGoogle Scholar
  10. 10.
    Stojanovich L, Zandman-Goddard G, Pavlovich S, Sikanich N (2007) Psychiatric manifestations in systemic lupus erythematosus. Autoimmun Rev 6(6):421–426. doi: 10.1016/j.autrev.2007.02.007 PubMedCrossRefGoogle Scholar
  11. 11.
    Kaposi ea. Neue Beiträge zur Kenntnis des Lupus erythematosus. Arch Dermat u Syph 1872(4):36–78Google Scholar
  12. 12.
    Buchbinder R, Hall S, Littlejohn GO, Ryan PF (1988) Neuropsychiatric manifestations of systemic lupus erythematosus. Aust NZ J Med 18(5):679–684CrossRefGoogle Scholar
  13. 13.
    Johnson RT, Richardson EP (1968) The neurological manifestations of systemic lupus erythematosus. Medicine (Baltimore) 47(4):337–369CrossRefGoogle Scholar
  14. 14.
    Adelowo OO, Oguntona AS, Ojo O (2009) Neuropsychiatric systemic lupus erythematosus among Nigerians. Afr J Med Med Sci 38(1):33–38PubMedGoogle Scholar
  15. 15.
    Robert M, Sunitha R, Thulaseedharan NK (2006) Neuropsychiatric manifestations systemic lupus erythematosus: a study from South India. Neurol India 54(1):75–77PubMedCrossRefGoogle Scholar
  16. 16.
    Ganz VH, Gurland BJ, Deming WE, Fisher B (1972) The study of the psychiatric symptoms of systemic lupus erythematosus: a biometric study. Psychosom Med 34(3):207–220PubMedGoogle Scholar
  17. 17.
    Wekking E (1993) Psychiatric symptoms in systemic lupus erythematosus: an update. Psychosom Med 55(2):219–228PubMedGoogle Scholar
  18. 18.
    Gibson T, Myers AR (1976) Nervous system involvement in systemic lupus erythematosus. Ann Rheum Dis 35(5):398–406CrossRefGoogle Scholar
  19. 19.
    EJ Feinglass, FC Arnett, CA Dorsch, TM Zizic, MB Stevens (1976) Neuropsychiatric manifestations of systemic lupus erythematosus: diagnosis, clinical spectrum, and relationship to other features of the disease. Medicine 55(4):323–339CrossRefGoogle Scholar
  20. 20.
    Stoll T, Kauer Y, Buchi S, Klaghofer R, Sensky T, Villiger PM (2001) Prediction of depression in systemic lupus erythematosus patients using SF-36 Mental Health scores. Rheumatology 40(6):695–698PubMedCrossRefGoogle Scholar
  21. 21.
    Maj M, Sartorius N (2002) Depressive disorders, 2nd edn. Wiley, ChichesterCrossRefGoogle Scholar
  22. 22.
    Kozora E, Ellison MC, West S (2006) Depression, fatigue, and pain in systemic lupus erythematosus (SLE): relationship to the American College of Rheumatology SLE neuropsychological battery. Arthritis Care Res 55(4):628–635CrossRefGoogle Scholar
  23. 23.
    Doria A, Rinaldi S, Ermani M, Salaffi F, Iaccarino L, Ghirardello A et al (2004) Health-related quality of life in Italian patients with systemic lupus erythematosus. II. Role of clinical, immunological and psychological determinants. Rheumatology 43(12):1580–1586PubMedCrossRefGoogle Scholar
  24. 24.
    Kawakatsu S, Wada T (2001) Rheumatic disease and depression. Nippon Rinsho 59(8):1578–1582PubMedGoogle Scholar
  25. 25.
    Freeman C, Tyrer P (1992) Research methods in psychiatry: a beginner’s guide, 2nd edn. Gaskell, LondonGoogle Scholar
  26. 26.
    Culbertson FM (1997) Depression and gender. An international review. Am Psychol 52(1):25–31PubMedCrossRefGoogle Scholar
  27. 27.
    Borimnejad L, Yekta ZP, Nasrabadi AN (2006) Lived experience of women suffering from vitiligo: a phenomenological study. Qual Rep 11(2):335–349Google Scholar
  28. 28.
    Scott J (1995) Prevention of depression: psychological and social measures. Adv Psychiatr Treat 1(4):94–101CrossRefGoogle Scholar
  29. 29.
    Bakhshani N, Kianpour M, Saravani M (2005) Epidemiology of mental disorders in Zahedan, IR Iran. The 2nd annual congress of epidemiology; Zahedan, Iran2004LGoogle Scholar
  30. 30.
    Pande I, Malaviya AN, Sekharan NG, Kailash S, Uppal SS, Kumar A (1994) SLE in Indian men: analysis of the clinical and laboratory features with a review of the literature. Lupus 3(3):181–186PubMedCrossRefGoogle Scholar
  31. 31.
    Ward MM, Marx AS, Barry NN (2002) Psychological distress and changes in the activity of systemic lupus erythematosus. Rheumatology (Oxford) 41(2):184–188CrossRefGoogle Scholar
  32. 32.
    Nery FG, Borba EF, Hatch JP, Soares JC, Bonfa E, Neto FL (2007) Major depressive disorder and disease activity in systemic lupus erythematosus. Compr Psychiatry 48(1):14–19PubMedCrossRefGoogle Scholar
  33. 33.
    Dobkin PL, Fortin PR, Joseph L, Esdaile JM, Danoff DS, Clarke AE (1998) Psychosocial contributors to mental and physical health in patients with systemic lupus erythematosus. Arthritis Care Res 11(1):23–31PubMedCrossRefGoogle Scholar
  34. 34.
    Haupt M (2004) Psychiatric disorders in rheumatic diseases, as exemplified by systemic lupus erythematosus (SLE). Z Rheumatol 63(2):122–130PubMedCrossRefGoogle Scholar
  35. 35.
    Lewis DA, Smith RE (1983) Steroid-induced psychiatric syndromes. A report of 14 cases and a review of the literature. J Affect Disord 5(4):319–332PubMedCrossRefGoogle Scholar
  36. 36.
    Hay EM, Black D, Huddy A, Creed F, Tomenson B, Bernstein RM et al (1992) Psychiatric disorder and cognitive impairment in systemic lupus erythematosus. Arthritis Rheumatism 35(4):411–416PubMedCrossRefGoogle Scholar
  37. 37.
    Greco CM, Kao AH, Sattar A, Danchenko N, Maksimowicz-McKinnon KM, Edmundowicz D et al (2009) Association between depression and coronary artery calcification in women with systemic lupus erythematosus. Rheumatology (Oxford) 48(5):576–581CrossRefGoogle Scholar
  38. 38.
    Miller GE, Stetler CA, Carney RM, Freedland KE, Banks WA (2002) Clinical depression and inflammatory risk markers for coronary heart disease. Am J Cardiol 90(12):1279–1283. doi: 10.1016/S0002-9149(02)02863-1 PubMedCrossRefGoogle Scholar
  39. 39.
    Karassa FB, Magliano M, Isenberg DA (2003) Suicide attempts in patients with systemic lupus erythematosus. Ann Rheum Dis 62(1):58–60PubMedCrossRefGoogle Scholar
  40. 40.
    Matsukawa Y, Sawada S, Hayama T, Usui H, Horie T (1994) Suicide in patients with systemic lupus erythematosus: a clinical analysis of seven suicidal patients. Lupus 3(1):31–35PubMedCrossRefGoogle Scholar
  41. 41.
    Iverson GL (2002) Screening for depression in systemic lupus erythematosus with the British Columbia Major Depression Inventory. Psychol Rep 90(3 Pt 2):1091–1096PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Zahra Zakeri
    • 1
  • Mansoor Shakiba
    • 2
  • Behzad Narouie
    • 3
    Email author
  • Nikol Mladkova
    • 4
  • Mohammad Ghasemi-Rad
    • 5
  • Alireza Khosravi
    • 6
  1. 1.Department of Internal Medicine, Ali-ebne-Abitaleb HospitalZahedan University of Medical SciencesZahedanIran
  2. 2.Department of PsychiatryZahedan University of Medical SciencesZahedanIran
  3. 3.Clinical Research Development Center, Ali-ebne-Abitaleb HospitalZahedan University of Medical SciencesZahedanIran
  4. 4.Blizzard, Institute of Cell and Molecular ScienceLondon, WhitechapelUK
  5. 5.Genius and Talented Student Organization, Student Research Center (SRC)Urmia University of Medical SciencesUrmiaIran
  6. 6.Department of Neurology, Ali-ebne-Abitaleb HospitalZahedan University of Medical SciencesZahedanIran

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