Anxiety, Depression Common in People With SLE and Lupus Nephritis

Several studies have shown that anxiety and depression are more common in people with systemic lupus erythematosus (SLE), but a new study suggests those mental disorders are even more common in people who have lupus nephritis (LN).

Co-authors Ying Hu, PhD, of the First Affiliated Hospital of Harbin (China) Medical University, and Ge Zhan, PhD, of the First Specialized Hospital of Harbin, said LN remains a major, life-threatening complication of SLE, with as many as 30% of people with LN eventually developing end-stage renal disease (ESRD). In addition, they said it is not uncommon for people with LN to experience anxiety, depression, and suicidality, all of which can affect treatment success and quality of life.

Previous studies have suggested that between one-third and one-half of people with SLE suffer from anxiety and/or depression. But Hu and Zhan said there is limited evidence to describe rates of those disorders among people with LN.

In their new study, published in the journal Immunity, Inflammation and Disease, the 2 investigators outlined the findings from the case-control study, in which they compared 3 cohorts of 50 patients: 1 cohort of people with SLE and LN, 1 cohort of people with SLE without LN, and 1 cohort of healthy controls. All participants were assessed using the Hospital Anxiety and Depression Scales for anxiety (HADS-A) and for depression (HADS-D). The investigators then compared rates to see whether LN increased the odds of anxiety or depression.

The answer, based on these participants, appeared to be “yes.” On the HADS-A, the median score among people with LN was 7.0, with an interquartile range of 6.0-10.0. On the HADS, scores of 7 and below are considered normal; scores of 8-10 represent borderline or mild cases. For people with non-LN SLE, the median score was 6.0. For the control group, the median score was 5.0. The rate of anxiety based on those scales was 38.0%, 28.0%, and 12.0% for people with SLE with LN, SLE without LN, and healthy controls, respectively.

Depression scores were even higher. The median HADS-D score for people with SLE and LN was 7.5, with an interquartile range of 6.0-11.0. The median score for people with SLE without LN was 6.0, and the median score for the control group was 4.0. The authors found a depression rate of 50% in the SLE-with-LN group, 30.0% in the non-LN SLE group, and 10.0% in the control group.

The investigators said possible reasons for the higher rates of anxiety and depression in people with LN could be that people with LN might be more likely to face events like pain, disability, discrimination, and social stress, or that LN brings with it the recruitment of pro-inflammaotry cytokines that could potentially raise the risk of anxiety and depression.

In the study, age, LN activity index scores, alopecia, 24-hour proteinuria, and C-reactive protein were all independently correlated with a higher risk of anxiety. Only 2 of those factors—age and LN activity index—were linked with a higher depression risk.

The authors said their study was limited in size, and it also did not attempt to investigate the underlying pathogenesis of anxiety and depression in these patients. Further studies will be needed in order to explore the pathogenesis of the conditions, Hu and Zhan said.

Still, they concluded that these data suggest that anxiety and depression are a significant concern for people with SLE, and particularly for those with both LN and SLE.

Reference

Hu Y, Zhan G. Anxiety and depression prevalence and their risk factors in lupus nephritis patients: a case-control study. ImmunInflamm Dis. 2022;10(9):e689. doi:10.1002/iid3.689