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14-02-2017 | Systemic lupus erythematosus | Article

Prevalence of depression and anxiety in systemic lupus erythematosus: a systematic review and meta-analysis

Journal: BMC Psychiatry

Authors: Lijuan Zhang, Ting Fu, Rulan Yin, Qiuxiang Zhang, Biyu Shen

Publisher: BioMed Central

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Abstract

Background

Systemic lupus erythematosus (SLE) patients are at high risk for depression and anxiety. However, the estimated prevalence of these disorders varies substantially between studies. This systematic review aimed to establish pooled prevalence levels of depression and anxiety among adult SLE patients.

Methods

We systematically reviewed databases including PubMed, Embase, PsycINFO, and the Cochrane database library from their inception to August 2016. Studies presenting data on depression and/or anxiety in adult SLE patients and having a sample size of at least 60 patients were included. A random-effect meta-analysis was conducted on all eligible data.

Results

A total of 59 identified studies matched the inclusion criteria, reporting on a total of 10828 adult SLE patients. Thirty five and thirteen methods of defining depression and anxiety were reported, respectively. Meta-analyses revealed that the prevalence of major depression and anxiety were 24% (95% CI, 16%-31%, I2 = 95.2%) and 37% (95% CI, 12%–63%, I2 = 98.3%) according to clinical interviews. Prevalence estimates of depression were 30% (95% CI, 22%–38%, I2 = 91.6%) for the Hospital Anxiety and Depression Scale with thresholds of 8 and 39% (95% CI, 29%–49%, I2 = 88.2%) for the 21-Item Beck Depression Inventory with thresholds of 14, respectively. The main influence on depression prevalence was the publication years of the studies. In addition, the corresponding pooled prevalence was 40% (95% CI, 30%–49%, I2 = 93.0%) for anxiety according to the Hospital Anxiety and Depression Scale with a cutoff of 8 or more.

Conclusions

The prevalence of depression and anxiety was high in adult SLE patients. It indicated that rheumatologists should screen for depression and anxiety in their patients, and referred them to mental health providers in order to identify effective strategies for preventing and treating depression and anxiety among adult SLE patients.

Trial registration

Current Meta-analysis PROSPERO Registration Number: CRD 42016044125. Registered 4 August 2016.
Literature
1.
Yilmaz-Oner S, Oner C, Dogukan FM, Moses TF, Demir K, Tekayev N, et al. Anxiety and depression predict quality of life in Turkish patients with systemic lupus erythematosus. Clin Exp Rheumatol. 2015;33(3):360–5.PubMed
2.
Kheirandish M, Faezi ST, Paragomi P, Akhlaghi M, Gharibdoost F, Shahali A, et al. Prevalence and severity of depression and anxiety in patients with systemic lupus erythematosus: An epidemiologic study in Iranian patients. Mod Rheumatol. 2015;25(3):405–9.CrossRefPubMed
3.
Bachen EA, Chesney MA, Criswell LA. Prevalence of mood and anxiety disorders in women with systemic lupus erythematosus. Arthritis Rheum. 2009;61(6):822–9.CrossRefPubMedPubMedCentral
4.
Ainiala H, Loukkola J, Peltola J, Korpela M, Hietaharju A. The prevalence of neuropsychiatric syndromes in systemic lupus erythematosus. Neurology. 2001;57(3):496–500.CrossRefPubMed
5.
Greco CM, Li T, Sattar A, Kao AH, Danchenko N, Edmundowicz D, et al. Association between depression and vascular disease in systemic lupus erythematosus. J Rheumatol. 2012;39(2):262–8.CrossRefPubMed
6.
Lisitsyna TA, Vel’tishchev D, Seravina OF, Kovalevskaia OB, Marchenko AS, Novikova DS, et al. Prevalence of mental disorders in SLE patients: correlations with the disease activity and comorbid chronic conditions. Ter Arkh. 2009;81(6):10–6.PubMed
7.
Mok CC, Chan KL, Cheung EF, Yip PS. Suicidal ideation in patients with systemic lupus erythematosus: incidence and risk factors. Rheumatology (Oxford). 2014;53(4):714–21.CrossRef
8.
Ward MM, Lotstein DS, Bush TM, Lambert RE, van Vollenhoven R, Neuwelt CM. Psychosocial correlates of morbidity in women with systemic lupus erythematosus. J Rheumatol. 1999;26(10):2153–8.PubMed
9.
Mak A, Tang CS, Ho RC. Serum tumour necrosis factor-alpha is associated with poor health-related quality of life and depressive symptoms in patients with systemic lupus erythematosus. Lupus. 2013;22(3):254–61.CrossRefPubMed
10.
Mok CC, Chan KL, Ho LY. Association of depressive/anxiety symptoms with quality of life and work ability in patients with systemic lupus erythematosus. Clin Exp Rheumatol. 2016;34(3):389–95.PubMed
11.
Xie LF, Chen PL, Pan HF, Tao JH, Li XP, Zhang YJ, et al. Prevalence and correlates of suicidal ideation in SLE inpatients: Chinese experience. Rheumatol Int. 2012;32(9):2707–14.CrossRefPubMed
12.
Doria A, Rinaldi S, Ermani M, Salaffi F, Iaccarino L, Ghirardello A, et al. Health-related quality of life in Italian patients with systemic lupus erythematosus. II. Role of clinical, immunological and psychological determinants. Rheumatology (Oxford). 2004;43(12):1580–6.CrossRef
13.
Bogdanovic G, Stojanovich L, Djokovic A, Stanisavljevic N. Physical Activity Program Is Helpful for Improving Quality of Life in Patients with Systemic Lupus Erythematosus. Tohoku J Exp Med. 2015;237(3):193–9.CrossRefPubMed
14.
Matcham F, Rayner L, Steer S, Hotopf M. The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology (Oxford). 2013;52(12):2136–48.CrossRef
15.
Stubbs B, Aluko Y, Myint PK, Smith TO. Prevalence of depressive symptoms and anxiety in osteoarthritis: a systematic review and meta-analysis. Age Ageing. 2016;45(2):228–35.CrossRefPubMed
16.
Meszaros ZS, Perl A, Faraone SV. Psychiatric symptoms in systemic lupus erythematosus: a systematic review. J Clin Psychiatry. 2012;73(7):993–1001.CrossRefPubMed
17.
Panic N, Leoncini E, de Belvis G, Ricciardi W, Boccia S. Evaluation of the endorsement of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement on the quality of published systematic review and meta-analyses. PLoS One. 2013;8(12):e83138.CrossRefPubMedPubMedCentral
18.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.CrossRefPubMed
19.
Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods. 2010;1(2):97–111.CrossRefPubMed
20.
Higgins JPT, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.CrossRefPubMedPubMedCentral
21.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.CrossRefPubMedPubMedCentral
22.
Sterne JA, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol. 2001;54(10):1046–55.CrossRefPubMed
23.
Greco CM, Kao AH, Sattar A, Danchenko N, Maksimowicz-McKinnon KM, Edmundowicz D, et al. Association between depression and coronary artery calcification in women with systemic lupus erythematosus. Rheumatology (Oxford). 2009;48(5):576–81.CrossRef
24.
Shen B, Tan W, Feng G, He Y, Liu J, Chen W, et al. The correlations of disease activity, socioeconomic status, quality of life, and depression/anxiety in Chinese patients with systemic lupus erythematosus. Clin Dev Immunol. 2013;2013:270878.CrossRefPubMedPubMedCentral
25.
Zhang L, Xia Y, Zhang Q, Fu T, Yin R, Guo G, et al. The correlations of socioeconomic status, disease activity, quality of life, and depression/anxiety in Chinese patients with rheumatoid arthritis. Psychol Health Med. 2017;22(1):28–36.CrossRefPubMed
26.
Westhoff G, Dörner T, Zink A. Fatigue and depression predict physician visits and work disability in women with primary Sjögren’s syndrome: results from a cohort study. Rheumatology (Oxford). 2012;51(2):262–9.CrossRef
27.
Mak A, Tang CS, Chan MF, Cheak AA, Ho RC. Damage accrual, cumulative glucocorticoid dose and depression predict anxiety in patients with systemic lupus erythematosus. Clin Rheumatol. 2011;30(6):795–803.CrossRefPubMed
28.
Tay SH, Cheung PP, Mak A. Active disease is independently associated with more severe anxiety rather than depressive symptoms in patients with systemic lupus erythematosus. Lupus. 2015;24(13):1392–9.CrossRefPubMed
29.
Buća A, Perković D, Martinović-Kaliterna D, Vlastelica M, Titlić M. Neuropsychiatric systemic lupus erythematosus: diagnostic and clinical features according to revised ACR criteria. Coll Antropol. 2009;33(1):281–8.PubMed
30.
Unterman A, Nolte JE, Boaz M, Abady M, Shoenfeld Y, Zandman-Goddard G. Neuropsychiatric Syndromes in Systemic Lupus Erythematosus: A Meta-Analysis. Semin Arthritis Rheum. 2011;41(1):1–11.CrossRefPubMed
31.
Hanly JG. ACR classification criteria for systemic lupus erythematosus: limitations and revisions to neuropsychiatric variables. Lupus. 2004;13(11):861–4.CrossRefPubMed
32.
Davey R, Bamford J, Emery P. The ACR classification criteria for headache disorders in SLE fail to classify certain prevalent headache types. Cephalalgia. 2008;28(3):296–9.CrossRefPubMed
33.
Hotopf M, Chidgey J, Addington-Hall J, Ly KL. Depression in advanced disease: a systematic review. Part 1. Prevalence and case finding. Palliat Med. 2002;16(2):81–97.CrossRefPubMed
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