title: Mood Disorders in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study.
abstract: OBJECTIVE
  To examine the frequency, characteristics, and outcome of mood disorders, as well as clinical and autoantibody associations, in a multiethnic/racial, prospective inception cohort of patients with systemic lupus erythematosus (SLE).
  
  
  METHODS
  Patients were assessed annually for mood disorders (4 types, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and 18 other neuropsychiatric events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 subscales, mental and physical component summary scores were collected. Time to event, linear and ordinal regressions, and multi-state models were used as appropriate.
  
  
  RESULTS
  Among the 1,827 patients with SLE, 88.9% were female, and 48.9% were Caucasian. The mean ± SD age of the patients was 35.1 ± 13.3 years, disease duration was 5.6 ± 4.8 months, and the length of followup was 4.7 ± 3.5 years. During the course of the study, 863 (47.2%) of the 1,827 patients had 1,627 neuropsychiatric events. Mood disorders occurred in 232 (12.7%) of 1,827 patients, and 98 (38.3%) of 256 mood disorder events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95% confidence interval 15.1, 20.2%). A greater risk of mood disorder was associated with concurrent neuropsychiatric events (P ≤ 0.01), and a lower risk was associated with Asian race/ethnicity (P = 0.01) and treatment with immunosuppressive drugs (P = 0.003). Mood disorders were associated with lower mental health and mental component summary scores but not with the SLEDAI-2K, SDI, or lupus autoantibodies. Among the 232 patients with depression, 168 (72.4%) were treated with antidepressants. One hundred twenty-six (49.2%) of 256 mood disorders resolved in 117 (50.4%) of 232 patients.
  
  
  CONCLUSIONS
  Mood disorders, the second most frequent neuropsychiatric event in patients with SLE, have a negative impact on health-related quality of life and improve over time. The lack of association with global SLE disease activity, cumulative organ damage, and lupus autoantibodies emphasizes the multifactorial etiology of mood disorders and a role for non-lupus-specific therapies.
authors.affiliation: Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: John G
authors.initials: JG
authors.lastname: Hanly
authors.affiliation: Institute of Public Health and University of Cambridge, University Forvie Site, Cambridge, UK.
authors.forename: Li
authors.initials: L
authors.lastname: Su
authors.affiliation: Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Urowitz
authors.affiliation: Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico.
authors.forename: Juanita
authors.initials: J
authors.lastname: Romero-Diaz
authors.affiliation: University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Gordon
authors.affiliation: Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea.
authors.forename: Sang-Cheol
authors.initials: SC
authors.lastname: Bae
authors.affiliation: McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Sasha
authors.initials: S
authors.lastname: Bernatsky
authors.affiliation: University of Calgary, Calgary, Alberta, Canada.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Clarke
authors.affiliation: Cedars-Sinai Medical Center and University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Wallace
authors.affiliation: Oklahoma Medical Research Foundation, Oklahoma City.
authors.forename: Joan T
authors.initials: JT
authors.lastname: Merrill
authors.affiliation: University College London, London, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Isenberg
authors.affiliation: University College London, London, UK.
authors.forename: Anisur
authors.initials: A
authors.lastname: Rahman
authors.affiliation: State University of New York Downstate Medical Center, Brooklyn.
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Ginzler
authors.affiliation: Johns Hopkins University, Baltimore, Maryland.
authors.forename: Michelle
authors.initials: M
authors.lastname: Petri
authors.affiliation: Manchester Academic Health Sciences Centre, University of Manchester, and Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: Ian N
authors.initials: IN
authors.lastname: Bruce
authors.affiliation: University of North Carolina, Chapel Hill.
authors.forename: M A
authors.initials: MA
authors.lastname: Dooley
authors.affiliation: Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, Quebec, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Fortin
authors.affiliation: Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Dafna D
authors.initials: DD
authors.lastname: Gladman
authors.affiliation: Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jorge
authors.initials: J
authors.lastname: Sanchez-Guerrero
authors.affiliation: Landspitali University Hospital, Reykjavik, Iceland.
authors.forename: Kristjan
authors.initials: K
authors.lastname: Steinsson
authors.affiliation: Northwestern University and Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Ramsey-Goldman
authors.affiliation: The Rayne Institute, St. Thomas' Hospital, and King's College London School of Medicine, London, UK.
authors.forename: Munther A
authors.initials: MA
authors.lastname: Khamashta
authors.affiliation: Feinstein Institute for Medical Research, Manhasset, New York.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Aranow
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Graciela S
authors.initials: GS
authors.lastname: Alarcón
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Barri J
authors.initials: BJ
authors.lastname: Fessler
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Susan
authors.initials: S
authors.lastname: Manzi
authors.affiliation: University Hospital Lund, Lund, Sweden.
authors.forename: Ola
authors.initials: O
authors.lastname: Nived
authors.affiliation: University Hospital Lund, Lund, Sweden.
authors.forename: Gunnar K
authors.initials: GK
authors.lastname: Sturfelt
authors.affiliation: Lanarkshire Centre for Rheumatology and Hairmyres Hospital, East Kilbride, UK.
authors.forename: Asad A
authors.initials: AA
authors.lastname: Zoma
authors.affiliation: Karolinska Institute, Stockholm, Sweden.
authors.forename: Ronald F
authors.initials: RF
authors.lastname: van Vollenhoven
authors.affiliation: Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Ramos-Casals
authors.affiliation: Hospital de Cruces and University of the Basque Country, Barakaldo, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ruiz-Irastorza
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: S Sam
authors.initials: SS
authors.lastname: Lim
authors.affiliation: University of California at San Diego, La, Jolla.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Kalunian
authors.affiliation: Istanbul University, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Inanc
authors.affiliation: Medical University of South Carolina, Charleston.
authors.forename: Diane L
authors.initials: DL
authors.lastname: Kamen
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Peschken
authors.affiliation: Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Soren
authors.initials: S
authors.lastname: Jacobsen
authors.affiliation: New York University, New York, New York.
authors.forename: Anca
authors.initials: A
authors.lastname: Askanase
authors.affiliation: Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Theriault
authors.affiliation: Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Kara
authors.initials: K
authors.lastname: Thompson
authors.affiliation: Institute of Public Health and University of Cambridge, University Forvie Site, Cambridge, UK.
authors.forename: Vernon
authors.initials: V
authors.lastname: Farewell
mesh_terms: D000328:Adult; D044466:Asian People; D001323:Autoantibodies / Q000097:blood; D044383:Black People; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D015994:Incidence; D038622:Internationality; D008180:Lupus Erythematosus, Systemic / Q000208:ethnology* / Q000276:immunology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012044:Regression Analysis; D044465:White People
chemical_list: D001323:Autoantibodies