title: Fatigue and depression predict physician visits and work disability in women with primary Sjögren's syndrome: results from a cohort study.
abstract: OBJECTIVE
  Patients with primary SS (pSS) are frequently suffering from multiple enduring disorders that raise the risk of work disability and require treatment by various health-care specialists. We aimed at determining predictors of physician visits and work disability in pSS patients.
  
  
  METHODS
  Physician visits within the past 6 months, employment status and sick leave were compared among 176 female pSS patients and 115 age-matched controls. Dryness, pain, fatigue and depression were assessed by rating scales of the EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), the Profile of Fatigue and Discomfort (PROFAD) and Patient Health Questionnaire depression measurements (PHQ-9). Factors associated with an increased number of physician visits and inability to work were determined by multivariate logistic regression analysis.
  
  
  RESULTS
  Patients and controls were comparable in age and education, but differed significantly in the prevalence of depression (38.1 vs 7.9%, P < 0.001), the number of physician visits [17.0 (10.0) vs 6.5 (4.5); P < 0.001] and gainful employment (≤64 years: 52.8 vs 77.1% P < 0.001). Multivariate regression analyses revealed that depression (PHQ-9) and/or fatigue, particularly lack of stamina, but not dryness, were significantly associated with physician visits and working status in pSS patients. Patients with high ratings for the statement 'I have had difficulties to keep going, was easily worn out or lacking in energy' had a highly increased risk of not being gainfully employed (adjusted OR 4.1; 95% CI 1.5, 11.2; P < 0.001).
  
  
  CONCLUSIONS
  In pSS, lack of stamina and/or depression cause a higher level of individual and societal burden than dry eyes and mouth. Fatigue and depression deserve more recognition as treatment targets in pSS.
authors.affiliation: Epidemiology Unit, German Rheumatism Research Centre Berlin, Charitéplatz 1, 10117 Berlin, Germany. westhoff@drfz.de
authors.forename: Gisela
authors.initials: G
authors.lastname: Westhoff
authors.forename: Thomas
authors.initials: T
authors.lastname: Dörner
authors.forename: Angela
authors.initials: A
authors.lastname: Zink
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D003866:Depressive Disorder / Q000175:diagnosis*; D004185:Disability Evaluation; D004651:Employment / Q000706:statistics & numerical data; D005221:Fatigue / Q000175:diagnosis*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D012859:Sjogren's Syndrome / Q000175:diagnosis*