Skip to main content

Advertisement

Log in

Evaluation of quality of life in relation to anxiety and depression in primary Sjögren’s syndrome

  • Original Article
  • Published:
Modern Rheumatology

Abstract

The aim of this study was to evaluate health-related quality of life (HR-QOL) in patients with primary Sjögren’s syndrome (pSS) using both Short-Form 36 (SF-36) and World Health Organization Quality of Life Assessment–BREF (WHOQOL-BREF) questionnaires and to determine the effects of anxiety and depression on HR-QOL using the Hospital Anxiety–Depression Scale (HADS). In this cross-sectional study, 107 female patients with pSS (mean age 54.10 ± 10.2 years), fulfilling US–European Consensus Criteria and 109 female controls (mean age 53.4 ± 10.9 years) were included. Student’s t test, Mann–Whitney U test, and analysis of variance (ANOVA) were used for statistical analysis. P values >0.05 were accepted as significant. All domains of the SF-36, with the exception of “Vitality”, and all domains of the WHOQOL-BREF with the exception of “Environment”, were significantly lower in pSS patients compared with healthy controls. In pSS patients having anxiety according to HADS, the scores of all domains of WHOQOL-BREF were significantly lower, and in patients having depression according to HADS, three of four domains of WHOQOL-BREF were significantly lower compared with the rest of the group. However, the scores of two domains of the SF-36, namely “Role-Physical” and “Role-Emotional” domains, were significantly higher in pSS patients having depression according to HADS. We confirmed the presence of impaired HR-QOL in pSS. Whereas the presence of anxiety and/or depression generally showed a negative affect on HR-QOL, interestingly, depression seemed to improve the scores of “Role-Physical” and “Role-Emotional” domains of the SF-36. This surprising finding might be related to adaptation to changing health. Social support based upon cultural traditions might also have contributed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Tzioufas AG, Mitsias ID, Mouthsopoulos HM. Sjögren’s syndrome. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, editors. Rheumatology, vol. II. 4th ed. Mosby: Elsevier; 2008. p. 1341–52.

    Google Scholar 

  2. Fox RI. Sjogren’s syndrome. Lancet. 2005;366:321–31.

    Article  CAS  PubMed  Google Scholar 

  3. Mitsias DI, Kapsogeorgou EK, Moutsopoulos HM. Sjogren’s syndrome: why autoimmune epithelitis? Oral Dis. 2006;12:523–32.

    Article  CAS  PubMed  Google Scholar 

  4. Kabasakal Y, Kitapcioglu G, Turk T, Oder G, Durusoy R, Mete N, et al. The prevalence of Sjögren’s syndrome in adult women. Scand J Rheumatol. 2006;35:379–83.

    Article  CAS  PubMed  Google Scholar 

  5. Thomas E, Hay EM, Hajeer A, Silman J. Sjögren’s syndrome: a community-based study of prevalence and impact. Br J Rheumatol. 1998;37:1069–76.

    Article  CAS  PubMed  Google Scholar 

  6. Boonen A, Rasker JJ, Stucki G. The international classification for functioning, disability and health. A challenge and a need for rheumatology. Clin Rheumatol. 2007;26:1803–8.

    Article  PubMed  Google Scholar 

  7. Szabo S. The World Health Organisation Quality of life (WHOQOL) assesment instrument. In: Spilker B, editor. Quality of life and pharmacoeconomics in clinical trials. 2nd edn. Philadelphia: Lipincot-Raven; 1996. p. 355–62.

  8. Stewart AL, Greenfield S, Hays RD, Wells K, Rogers WH, Berry SD, et al. Functional status and well-being of patients with chronic conditions. Results from the medical outcomes study. J Am Med Assoc. 1989;262:907–13.

    Article  CAS  Google Scholar 

  9. Meijer JM, Meiners PM, Huddleston Slater JJ, Spijkervet FK, Kallenberg CG, Vissink A, et al. Health-related quality of life, employment and disability in patients with Sjogren’s syndrome. Rheumatology (Oxford). 2009;48(9):1077–82.

    Article  Google Scholar 

  10. Bjerrum K, Prause JU. Primary Sjogren’s syndrome: a subjective description of the disease. Clin Exp Rheumatol. 1990;8:283–8.

    CAS  PubMed  Google Scholar 

  11. The WHOQOL Group. Development of the WHOQOL: rationale and current status. Int J Ment Health. 1994;23(3):24–56.

    Google Scholar 

  12. The WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998;28:551–8.

    Article  Google Scholar 

  13. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83.

    Article  PubMed  Google Scholar 

  14. Bjelland I, Dahl AA, Haung TT, Neckelman D. The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res. 2002;52:69–77.

    Article  PubMed  Google Scholar 

  15. Fidaner H, Elbi H, Fidaner C, Eser SY, Eser E, Goker E. Measuring quality of life WHOQOL-100 and WHOQOL-bref. J Psychiatr Psychol Psychopharmacol. 1999;7:23–41.

    Google Scholar 

  16. Koçyigit H, Aydemir O, Fisek G, Olmez N, Memis A. Turkish validity and reliability of short-form 36. Drug Treat. 1999;12:102–6.

    Google Scholar 

  17. Dündar P, Fidaner C, Fidaner H, Oral A, Eser S, Atman UC, et al. Comparing the Turkish versions of WHOQOL-BREF and SF-36. Convergent validity of WHOQOL-BREF and SF-36. Hippokratia. 2002;6(Suppl 1):37–43.

    Google Scholar 

  18. Aydemir Ö, Güvenir T, Küey L, Kültür S. Hastane Anksiyete ve Depresyon Ölçeği Türkçe Formunun geçerlilik ve güvenilirliği. Türk Psikiyatri Derg. 1997;8:187–280.

    Google Scholar 

  19. Bowman SJ, Booth DA, Platts RG. Measurement of fatigue and discomfort in primary Sjogren’s syndrome using a new questionnaire tool. Rheumatology. 2004;43:758–64.

    Article  CAS  PubMed  Google Scholar 

  20. McMillan AS, Leung KC, Leung WK, Wong MC, Lau CS, Mok TM. Impact of Sjögren’s syndrome on oral health-related quality of life in southern Chinese. J Oral Rehabil. 2004;31(7):653–9.

    Article  CAS  PubMed  Google Scholar 

  21. Rostron J, Rogers S, Longman L, Kaney S, Field EA. Health-related quality of life in patients with primary Sjögren’s syndrome and xerostomia: a comparative study. Gerodontology. 2002;19(1):53–9.

    Article  PubMed  Google Scholar 

  22. Segal B, Bowman SJ, Fox PC, Vivino FB, Murukutla N, Brodscholl J, et al. Primary Sjögren’s syndrome: health experiences and predictors of health quality among patients in the United States. Health Qual Life Outcomes. 2009;27(7):46.

    Article  Google Scholar 

  23. Baturone R, Soto M, Marquez M, Macias I, Montes de Oca M, Medina F, et al. Health-related quality of life in patients with primary Sjogren’s syndrome: relationship with serum levels of proinflammatory cytokines. Scand J Rheumatol. 2009;2:1–4.

    Google Scholar 

  24. Belenguer R, Ramos-Casals M, Brito-Zerón P, del Pino J, Sentís J, Aguiló S, et al. Influence of clinical and immunological parameters on the health-related quality of life of patients with primary Sjögren’s syndrome. Clin Exp Rheumatol. 2005;23(3):351–6.

    CAS  PubMed  Google Scholar 

  25. Strömbeck B, Ekdahl C, Manthorpe R, Wikström I, Jacobsson L. Health-related quality of life in primary Sjögren’s syndrome, rheumatoid arthritis and fibromyalgia compared to normal population data using SF-36. Scand J Rheumatol. 2000;29(1):20–8.

    Article  PubMed  Google Scholar 

  26. Stewart CM, Berg KM, Cha S, Reeves WH. Salivary dysfunction and quality of life in Sjögren syndrome: a critical oral-systemic connection. J Am Dent Assoc. 2008;139(3):291–9.

    PubMed  Google Scholar 

  27. Sutcliffe N, Stoll T, Pyke S, Isenberg DA. Functional disability and end organ damage in patients with systemic lupus erythematosus (SLE), SLE and Sjogren’s syndrome (SS), and primary SS. J Rheumatol. 1998;25:63–8.

    CAS  PubMed  Google Scholar 

  28. Tensing EK, Solovieva SA, Tervahartiala T, Nordström DC, Laine M, Niissalo S, et al. Fatigue and health profile in sicca syndrome of Sjogren’s and non-Sjogren’s syndrome origin. Clin Exp Rheumatol. 2001;19:313–6.

    CAS  PubMed  Google Scholar 

  29. Champey J, Corruble E, Gottenberg JE, Buhl C, Meyer T, Caumont C, et al. Quality of life and psychological status in patients with primary Sjögren’s syndrome and sicca symptoms without autoimmune features. Arthritis Rheum (Arthritis Care Res). 2006;55:451–7.

    Article  Google Scholar 

  30. Stevenson HA, Jones ME, Rostron JL, Longman LP, Field EA. UK patients with primary Sjögren’s syndrome are at increased risk from clinical depression. Gerodontology. 2004;21:141–5.

    Article  CAS  PubMed  Google Scholar 

  31. Valtýsdóttir ST, Gudbjörnsson B, Hällgren R, Hetta J. Psychological well-being in patients with primary Sjögren’s syndrome. Clin Exp Rheumatol. 2000;18(5):597–600.

    PubMed  Google Scholar 

  32. Valtýsdóttir ST, Gudbjörnsson B, Lindqvist U, Hällgren R, Hetta J. Anxiety and depression in patients with primary Sjögren’s syndrome. J Rheumatol. 2000;27(1):165–9.

    PubMed  Google Scholar 

  33. Kuyken W, Orley J, Hudelson P, Sartorius N. Quality of life assessment across cultures. Int J Ment Health. 1994;23:5–27.

    Google Scholar 

  34. Huang PC, Fang CT, Chang YY, Chen MY, Wang JD. Comparison of WHOQOL-BREF and SF-36 in patients with HIV infection. Qual Life Res. 2005;14:141–50.

    Article  Google Scholar 

  35. Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, et al. European Study Group on Classification Criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002;61:554–8.

    Article  CAS  PubMed  Google Scholar 

  36. Wolfe F, Smythe HA, Yunus MB, Bennet RM, Bombardieri C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum. 1990;33:160–72.

    Article  CAS  PubMed  Google Scholar 

  37. Garcia-Carrasco M, Ramos-Casals M, Rosas J, Pallares L, Calvo-Alen J, Cervera R, et al. Primary Sjogren syndrome: clinical and immunologic disease patterns in a cohort of 400 patients. Medicine (Baltimore). 2002;81:270–80.

    Article  Google Scholar 

  38. Ubel PA, Loewenstein G, Jepson C. Whose quality of life? A commentary exploring discrepancies between health state evaluations of patients and the general public. Qual Life Res. 2003;12:599–607.

    Article  PubMed  Google Scholar 

  39. Hoffman DL, Dukes EM. The health status burden of people with fibromyalgia: a review of studies that assessed health status with the SF-36 or the SF-12. Int J Clin Pract. 2008;62(1):115–26.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest statement

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gonca Karabulut.

About this article

Cite this article

Inal, V., Kitapcioglu, G., Karabulut, G. et al. Evaluation of quality of life in relation to anxiety and depression in primary Sjögren’s syndrome. Mod Rheumatol 20, 588–597 (2010). https://doi.org/10.1007/s10165-010-0329-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10165-010-0329-z

Keywords

Navigation