title: Determinants of disability, quality of life and depression in dermatological patients with systemic scleroderma.
abstract: BACKGROUND
  Systemic scleroderma (SSc) is a rare disease and knowledge about the relationship between clinical signs, disability, quality of life and depressive symptoms is still limited. Although patients with SSc are frequently treated by dermatologists, the vast majority of published evidence is based on rheumatological samples.
  
  
  OBJECTIVE
  To identify determinants of disability, decreased quality of life, and depression in a sample of dermatological patients with SSc.
  
  
  METHODS
  This was a cross-sectional study on consecutive patients with SSc attending one specialist dermatological centre between April 2008 and November 2009. Validated questionnaires, the Health Assessment Questionnaire (HAQ), EuroQol (EQ-5D) and the Center for Epidemiologic Studies Depression scale (CES-D) were utilized to measure disability, quality of life and depressive symptoms. Additionally, disease characteristics (SSc subtype, skin thickness, organ involvement), subjective symptoms of SSc, treatment and socioeconomic characteristics were collected by trained investigators. Based on an a priori hypothesized causal model, multivariate logistic regression models were used to analyse determinants of disability, quality of life and depression in patients with SSc.
  
  
  RESULTS
  A total of 72 patients [59 female (82%), mean age 59years] were enrolled. According to the CES-D, 69% (48 out of 70) were screened positive for depression. Quality of life impairment and female sex and were independent risk factors for depressive symptoms. Disease-specific disability was the main determinant of quality of life impairment in SSc. Pain involvement of the musculoskeletal system and male sex were the main determinants of disability in our sample of patients with SSc.
  
  
  CONCLUSIONS
  The high psychosomatic morbidity in our sample of consecutive patients with SSc calls for the investigation of interdisciplinary models of care.
authors.affiliation: Department of Dermatology, Technical University of Dresden, Dresden, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Müller
authors.forename: P
authors.initials: P
authors.lastname: Rehberger
authors.forename: C
authors.initials: C
authors.lastname: Günther
authors.forename: J
authors.initials: J
authors.lastname: Schmitt
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology* / Q000517:prevention & control; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012595:Scleroderma, Systemic / Q000523:psychology*; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires