Department of Medicine/Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
Department of Epidemiology, Emory University School of Public Health, Atlanta, Georgia, USA.
Lupus Sci Med. 2022 Aug;9(1). doi: 10.1136/lupus-2022-000697.
Depression is common in individuals with chronic cutaneous lupus erythematosus (CCLE). However, how CCLE may impact patients' psychological well-being is poorly understood, particularly among disproportionally affected populations. We examined the relationships between depression and psychosocial factors in a cohort of predominantly Black patients with primary CCLE (CCLE without systemic manifestations).
Cross-sectional assessment of individuals with dermatologist-validated diagnosis of primary CCLE. NIH-PROMIS short-forms were used to measure depression, disease-related stigma, social isolation and emotional support. Linear regression analyses (ɑ=0.05) were used to test an a priori conceptual model of the relationship between stigma and depression and the effect of social isolation and emotional support on that association.
Among 121 participants (87.6% women; 85.1% Black), 37 (30.6%) reported moderate to severe depression. Distributions of examined variables divided equally among those which did (eg, work status, stigma (more), social isolation (more), emotional support (less)) and did not (eg, age, sex, race, marital status) significantly differ by depression. Stigma was significantly associated with depression (b=0.77; 95% CI0.65 to 0.90), whereas social isolation was associated with both stigma (b=0.85; 95% CI 0.72 to 0.97) and depression (b=0.70; 95% CI0.58 to 0.92). After controlling for confounders, stigma remained associated with depression (b=0.44; 95% CI0.23 to 0.66) but lost significance (b=0.12; 95% CI -0.14 to 0.39) when social isolation (b=0.40; 95% CI 0.19 to 0.62) was added to the model. Social isolation explained 72% of the total effect of stigma on depression. Emotional support was inversely associated with depression in the univariate analysis; however, no buffer effect was found when it was added to the multivariate model.
Our findings emphasise the psychosocial challenges faced by individuals living with primary CCLE. The path analysis suggests that stigmatisation and social isolation might lead to depressive symptoms. Early clinical identification of social isolation and public education demystifying CCLE could help reduce depression in patients with CCLE.
慢性皮肤红斑狼疮（CCLE）患者常伴有抑郁。然而，CCLE 如何影响患者的心理健康尚不清楚，尤其是在受影响较大的人群中。我们在一组主要为黑人的原发性 CCLE（无系统表现的 CCLE）患者中，研究了抑郁与社会心理因素之间的关系。
对经皮肤科医生确诊的原发性 CCLE 患者进行横断面评估。采用 NIH-PROMIS 简式量表评估抑郁、疾病相关耻辱感、社会孤立和情感支持。采用线性回归分析（ɑ=0.05），检验耻辱感与抑郁之间关系的理论模型以及社会隔离和情感支持对这种关联的影响。
在 121 名参与者中（87.6%女性；85.1%为黑人），37 名（30.6%）报告有中重度抑郁。按抑郁状况将所测变量分为两组，抑郁组和非抑郁组在工作状态、耻辱感（更多）、社会孤立（更多）、情感支持（更少）等方面分布均衡，在年龄、性别、种族、婚姻状况等方面无显著差异。耻辱感与抑郁显著相关（b=0.77；95%CI0.65 至 0.90），而社会孤立与耻辱感（b=0.85；95%CI0.72 至 0.97）和抑郁（b=0.70；95%CI0.58 至 0.92）均相关。调整混杂因素后，尽管耻辱感仍与抑郁相关（b=0.44；95%CI0.23 至 0.66），但当加入社会孤立（b=0.40；95%CI0.19 至 0.62）时，其相关性不再显著（b=0.12；95%CI-0.14 至 0.39）。社会孤立解释了耻辱感对抑郁总效应的 72%。情感支持在单变量分析中与抑郁呈负相关；然而，当将其纳入多变量模型时，未发现缓冲效应。
我们的研究结果强调了原发性 CCLE 患者所面临的社会心理挑战。路径分析表明，耻辱感和社会孤立可能导致抑郁症状。早期识别社会孤立和对 CCLE 进行公众教育，以消除其神秘感，可能有助于减少 CCLE 患者的抑郁。
