title: Depression, Anxiety and Disease-Related Variables and Quality of Life Among Individuals With Systemic Lupus Erythematosus Living in Kermanshah Province, Iran.
abstract: BACKGROUND
  Health-related quality of life (HRQoL) is affected by numerous variables including depression and anxiety. However, these associations have not yet been described among patients with systemic lupus erythematosus (SLE) and the impact of SLE-related clinical variables remains unknown.
  
  
  OBJECTIVE
  In this cross-sectional study, the prevalence of depression and anxiety among Iranian patients with SLE living in Kermanshah province, Iran, has been estimated and the determinants of HRQoL in comparison with healthy subjects have been identified.
  
  
  METHODS
  Sampling was performed based on recruitment of subjects according to inclusion and exclusion criteria. Systemic lupus erythematosus-related variables including cutaneous manifestations, pericarditis, arthritis, history of seizure and psychosis were recorded. Blood samples were taken to measure antinuclear antibodies (ANA), anti-double stranded DNA (anti-dsDNA), Anti-Smith (Anti-SM), anticardiolipin antibody. Matched healthy subjects in demographic characteristics were selected from general population of Kermanshah province, Iran. Depression and anxiety and HRQoL were assessed using the Beck depression inventory-II, Beck anxiety inventory and short-form 36 health survey, respectively.
  
  
  RESULTS
  A total of 310 individuals (160 patients with SLE and 150 healthy subjects) participated in this study. The prevalence of depression and anxiety was about 20% among people with SLE, which was noticeably high but not significantly different from healthy individuals. More severe depression was associated with lower scores in domains of physical functioning (PF), role limitation due to physical problems (RP) and subsequently physical component summary (PCS) in the SLE group (P < 0.0001 for all). A higher anxiety level was negatively correlated with PF, RP, social functioning (SF), general health (GH) and PCS in the SLE group (P = 0.01, < 0.0001, 0.004, 0.02 and 0.005, respectively). Scores of PF and PCS were significantly lower among patients with SLE compared to the control group (P = 0.001 for both). Malar rash, photosensitivity, discoid rash, pleuritis, pericarditis, history of seizure and positive Anti-SM Ab were associated with poorer SF (P = 0.003, 0.003, 0.018, 0.001, < 0.0001, 0.021 and 0.002, respectively).
  
  
  CONCLUSIONS
  The results of this study show that patients with SLE have poorer HRQoL in physical components whereas the mental component of QoL is relatively similar to healthy individuals. Depression and anxiety were not related to clinical manifestations of SLE. However, the SF domain of HRQoL was the most susceptible component of QoL, which was affected by SLE clinical variables. The high estimated prevalence of depression and anxiety among patients with SLE requires attention.
authors.affiliation: Psychiatry Department, Farabi Hospital, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran.
authors.forename: Hania
authors.initials: H
authors.lastname: Shakeri
authors.affiliation: Psychiatry Department, Farabi Hospital, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran.
authors.forename: Farid
authors.initials: F
authors.lastname: Arman
authors.affiliation: Psychiatry Department, Farabi Hospital, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran.
authors.forename: Monir
authors.initials: M
authors.lastname: Hossieni
authors.affiliation: Nephrology Department, Kermanshah University of Medical Sciences, Kermanshah, IR Iran.
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Omrani
authors.affiliation: Psychiatry Department, Farabi Hospital, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Vahdani
authors.affiliation: Psychiatry Department, Farabi Hospital, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran.
authors.forename: Jalal
authors.initials: J
authors.lastname: Shakeri
keywords: Anxiety; Depression; Quality of Life; Systemic Lupus Erythematosus