title: Major depressive disorder and disease activity in systemic lupus erythematosus.
abstract: The association between psychosocial factors and systemic lupus erythematosus (SLE) is still a matter of discussion. Mood disorders may represent neuropsychiatric manifestations of SLE disease activity or may be a consequence of the stress of having a chronic major disease. We examined the hypothesis that SLE disease activity is related to the presence and severity of major depression in patients with SLE. Seventy-one patients with SLE were evaluated for the presence and intensity of major depressive disorder, psychosocial stressors, functional disability, SLE disease activity, and cumulative damage. Patients with major depression presented a trend toward having greater severity of SLE disease activity compared with those without major depression (P = .056). Major depression was also associated with life events (P = .017) and hassles (P < .001). Reinforcing these findings, depression severity was directly correlated with disease activity (r = 0.26, P = .026) and with functional disability (r = 0.46, P < .001). Moreover, multiple linear regression analysis, controlling for stressful life events and previous major depressive episodes, demonstrated that SLE disease activity still was associated with depression severity (P = .014). In conclusion, these results support the hypothesis that SLE disease activity is a potential risk factor for the presence and severity of major depression in patients with SLE. Whether major depression in active SLE is a central nervous system manifestation of the disease that is mediated by an autoimmune mechanism deserves further research.
authors.affiliation: Department of Psychiatry, University of São Paulo Medical School, São Paulo 01060-970 Brazil. nery@uthscsa.edu
authors.forename: Fabiano G
authors.initials: FG
authors.lastname: Nery
authors.forename: Eduardo F
authors.initials: EF
authors.lastname: Borba
authors.forename: John P
authors.initials: JP
authors.lastname: Hatch
authors.forename: Jair C
authors.initials: JC
authors.lastname: Soares
authors.forename: Eloísa
authors.initials: E
authors.lastname: Bonfá
authors.forename: Francisco Lotufo
authors.initials: FL
authors.lastname: Neto
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008016:Life Change Events; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D011241:Prednisone / Q000627:therapeutic use; D011584:Psychology; D012720:Severity of Illness Index
chemical_list: D000893:Anti-Inflammatory Agents; D011241:Prednisone