Division of Pediatric Rheumatology, Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
Department of Neurosciences and Mental Health, Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada.
Lupus. 2024 Jul;33(8):874-885. doi: 10.1177/09612033241254170. Epub 2024 May 22.
Depressive and anxiety symptoms are common in childhood-onset systemic lupus erythematosus (cSLE), yet their etiology and course remain unclear. We investigated the frequency of depressive and anxiety symptoms longitudinally in youth with cSLE, and associated socio-demographic and disease factors.
Participants 8-18 years with cSLE completed baseline measures [demographic questionnaire, Center for Epidemiologic Studies Depression Scale for Children (CES-DC), Screen for Childhood Anxiety Related Disorders (SCARED), and psychiatric interview] and follow-up measures (CES-DC and SCARED) > 6 months later. Prevalence of clinically significant depressive (score >15 on CES-DC) or anxiety symptoms (score 25 on SCARED) was calculated at baseline and follow-up. Baseline psychiatric interview diagnoses were tabulated. Relationships between socio-demographics (neighborhood-level material deprivation, ethnic concentration, adverse childhood event history, psychiatric condition in a first-degree relative), disease-related factors (disease duration, major organ disease, disease activity, glucocorticoid use, comorbid medical condition) and baseline depressive and anxiety scores, were examined in linear regression models. Factors with univariate associations with < 0.2 were included in multivariable adjusted models.
At baseline, of 51 participants with a mean disease duration of 4.3 years (SD 2.7), 35% ( = 18) and 35% ( = 18) had clinically significant depressive and anxiety symptoms, respectively. Anxiety disorder was diagnosed by psychiatric interview in 14% ( = 7), depressive disorders in 6% ( = 3), and post-traumatic stress disorder in 4% ( = 2). Adverse childhood events and first-degree relative with psychiatric condition were present in 40% ( = 20) and 37% ( = 18), respectively. In multivariable regression analysis, baseline depressive symptoms were positively correlated with neighbourhood-level material deprivation (β = 4.2, 95% CI [1.0, 7.3], = 0.01) and psychiatric condition in a first-degree relative (β = 7.3, 95% CI [2.2, 12.4], = 0.006). No associations were found between baseline anxiety scores and patient factors. At a median follow-up of 13.5 months (IQR 10.5, 18) for CES-DC ( = 34) and SCARED ( = 44), depressive and anxiety symptoms were persistent (18%, = 6; 16%, = 7), and newly present (24%, = 8; 16% = 7) at follow-up.
In this sample, depressive and anxiety symptoms were prevalent and persistent. Depressive symptoms correlated with neighborhood-level material deprivation, and family psychiatric history. These findings support routine psychosocial assessment in cSLE, and provision of appropriate resources.
抑郁和焦虑症状在儿童期发病的系统性红斑狼疮（cSLE）中很常见，但它们的病因和病程仍不清楚。我们调查了患有 cSLE 的青少年中抑郁和焦虑症状的纵向发生频率，以及相关的社会人口统计学和疾病因素。
8-18 岁的 cSLE 参与者完成了基线测量（人口统计学问卷、儿童流行病学研究抑郁量表（CES-DC）、儿童焦虑相关障碍筛查量表（SCARED）和精神病学访谈），并在 >6 个月后进行了随访测量（CES-DC 和 SCARED）。在基线和随访时计算了临床上显著的抑郁症状（CES-DC 得分>15）或焦虑症状（SCARED 得分>25）的患病率。列出了基线时的精神病学访谈诊断。在线性回归模型中，检查了社会人口统计学因素（邻里水平物质贫困、族裔集中、童年不良事件史、一级亲属中的精神疾病）和疾病相关因素（疾病持续时间、主要器官疾病、疾病活动度、糖皮质激素使用、合并医疗状况）与基线抑郁和焦虑评分之间的关系。单变量关联 <0.2 的因素被纳入多变量调整模型。
在基线时，51 名平均疾病持续时间为 4.3 年（SD 2.7）的参与者中，分别有 35%（=18）和 35%（=18）有临床上显著的抑郁和焦虑症状。精神病学访谈诊断为焦虑障碍 14%（=7），抑郁障碍 6%（=3），创伤后应激障碍 4%（=2）。40%（=20）和 37%（=18）的参与者分别有童年不良事件和一级亲属中有精神疾病。在多变量回归分析中，基线抑郁症状与邻里水平物质贫困呈正相关（β=4.2，95%CI[1.0，7.3]，=0.01），与一级亲属中的精神疾病状况呈正相关（β=7.3，95%CI[2.2，12.4]，=0.006）。基线焦虑评分与患者因素之间无关联。在 CES-DC（=34）和 SCARED（=44）的中位随访时间为 13.5 个月（IQR 10.5，18）时，抑郁和焦虑症状持续存在（18%，=6；16%，=7），且在随访时新出现（24%，=8；16%，=7）。
在本样本中，抑郁和焦虑症状普遍存在且持续存在。抑郁症状与邻里水平物质贫困和家庭精神病史相关。这些发现支持对 cSLE 进行常规社会心理评估，并提供适当的资源。
