| Abstract |
Introduction: Patients with SLE often experience mental disorders, mainly anxiety disorder and depression. The association with disease activity is controversial. In addition, poor adherence to treatment is common and has been found to be associated with depression.
Aim: The investigation of the correlation between the presence of mental disorders and disease activity in adult patients with SLE, the assessment of anxiety and depression levels in relation to the change in disease activity and the correlation between the presence of mental disorders and treatment adherence.
Methods: An observational study with two assessment periods was conducted at the autoimmune connective tissue diseases regular clinics of the University General Hospital of Heraklion (PAGNI). The target population was adult patients with active SLE, residents of Crete, aged 18-65. Patients were enrolled during the period May-September 2021. Patients diagnosed with coexistence of rheumatic disease, dementia, malignancy, active neuropsychiatric lupus and pregnant women were excluded. Anxiety and depression levels were assessed using HADS scale and SLEDAI-2K scale was used to assess disease activity during the inclusion visit and their follow-up visit after 4-6 months. Treatment adherence was assessed using the MMAS-4 scale. Data on socio-demographic factors, comorbidities and type of treatment were collected from medical records. Qualitative data were analyzed by descriptive statistics. Univariate correlations between anxiety/depression levels and qualitative variables were performed with x2 test, while t-test for independent samples was used for correlations with the quantitative variables. The existence of a linear correlation between the changes of HADS-A, HADS-D and SLEDAI-2K scores was investigated using spearman correlation test. Finally, a multivariate logistic regression was performed to assess risk factors for high anxiety and depression levels.
Results: High levels of anxiety (70%-80%) and depression (52.5%) were found in the sample of the study (40 patients). No statistically significant correlation was found between disease activity and anxiety levels (p-value = 0.3) and depression levels (p-value=0.8). In addition, no correlation was found between HADS-A/HADS-D and SLEDAI-2K changes, after 4-6 months. After adjusting for confounding variables, work correlated with reduced risk of developing high anxiety levels (OR=0.871) and high depression levels (OR=0.83). Αnxiety and depression levels were not significantly correlated with other socio-demographic factors or comorbidities. Treatment non-adherence presented high frequency in the sample (n=19 patients), however, no correlation with anxiety (p-value=0.63) and depression levels (p-value=0.52) was found.
Conclusion: Mental disorders, anxiety disorder and depression, are common in SLE patients, regardless of disease activity level implicating the need for further therapeutic approaches, orientation of health policies in holistic and personalized care. Physicians sensibilization in the detection of common mental disorders and increased vigilance as far as treatment adherence is concerned are necessary. The conduction of larger scale studies would be useful to determine the effect of mental illness on the disease clinical course and treatment adherence.
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Ψυχικές διαταραχές σε ασθενείς με Συστηματικό Ερυθηματώδη Λύκο: μία συγχρονική μελέτη στην Κρήτη
