Depression in pediatric SLE matches average rates



Children and adolescents with systemic lupus erythematosus do not have significantly more depression than does the general population of the same age, according to an assessment of 54 pediatric lupus patients at one Canadian center.

"The overall percentage of children and adolescents reporting depressive symptoms was within the range reported in the general adolescent population," said Sara Ahola Kohut, Ph.D.

The finding suggests that "childhood-onset systemic lupus erythematosus [SLE] may not be an additional risk factor for depression," they reported (Lupus 2013;22:712-20).

But despite these "encouraging" findings, health care providers should be aware of, and continue to screen for, depressive symptoms in this at-risk population, children and adolescents with SLE, said Dr. Kohut, a pediatric pain researcher at the Hospital for Sick Children in Toronto.

Dr. Kohut and her associates at the hospital and at the University of Toronto assembled and reviewed two groups of SLE patients during April 2010-January 2012. All patients enrolled in the two groups had been diagnosed with SLE at the Hospital for Sick Children prior to reaching the age of 18. The 38 patients who supplied data in cohort 1 were aged 10-18 years and had been first diagnosed within the prior 18 months. Based on their demographics and disease characteristics, they were representative of a broader group of 41 other patients with childhood-onset SLE (cSLE) seen at the hospital during this period who did not participate in the study.

All 16 patients who provided data in the second cohort were aged 18-24 years and had been diagnosed at least 3 years previously at the hospital. Again, these patients did not significantly differ by demographics or disease duration from 81 other potentially eligible patients who elected not to participate.

The average age of the patients in cohort 1 was 14 years; 84% were girls, and they had been diagnosed with SLE for an average of 11 months. Sixteen of the 38 had been diagnosed with neuropsychiatric SLE (NPSLE).

Patients in cohort 1 underwent assessment with the Children’s Depression Inventory. Their mean total and subscale scores fell into the nondepressed range. Ten of the 38 (26%) had elevated depression scores, and three (8%) had clinically significant depression scores, but none of the patients endorsed suicidality.

The average age of patients in cohort 2 was 22 years; all were women, and their average time since diagnosis of SLE was nearly 8 years. Half had been diagnosed with NPSLE.

Cohort 2 patients were assessed with the Beck Depression Inventory II. Once again, the average scores of the 16 patients did not fall into the depressed range for both their total Beck score and their subscale scores, and none of the 16 endorsed suicidality. Seven of the 16 (44%) had elevated depression scores on the Beck Inventory, with two of them scoring in the moderate to severe range for depressive symptoms. The prevalence of elevated depression scores in this cohort included half of the 8 patients previously diagnosed with NPSLE and three of the eight without a neuropsychiatric diagnosis.

The prevalence of depression in cohorts 1 and 2 did not differ significantly.

The analysis also looked at the severity of the more prevalent symptoms of depression in each of the two cohorts. In cohort 1, the most severe symptoms were fatigue, school problems, indecisiveness, despair, and sleep disturbances. In cohort 2, the most common symptoms were physical, and the most severe symptoms were sleep disturbances, loss of energy, fatigue, and changes in appetite.

"SLE is a chronic disease with symptoms of active disease that may include fatigue, sleep disturbances, and anorexia; therefore it is not surprising that physical depressive symptoms were the most frequent," said Dr. Kohut and her associates. "It may be more useful to monitor affective mood disorders (e.g., irritability, negative mood, negative self-esteem, worthlessness) when assessing depression in cSLE patients as these symptoms are less likely to coincide with symptoms of active SLE leading to (falsely) elevated composite depression scores," they noted.

The percentage of cSLE patients in the study with elevated levels of negative mood measures, including affective symptoms, and cognitive depressive symptoms was consistent with what has been previously reported for the general adolescent population. In addition, the authors noted that the children and adolescents who had previously been diagnosed with NPSLE did not have significantly higher depression scores than those of the cSLE patients without the neuropsychiatric diagnosis.

"The CDI and BDI-II remain valid instruments to screen for mood disorders. However, our paper highlights the utility of identifying which items children and adolescents with cSLE endorse. The CDI includes subscales to facilitate the identification of mood-related indicators such as the Negative Mood subscale," Dr. Kohut said in an interview. "To screen specifically for affective mood indicators, health care professionals may ask about loss of interest, the last time the patients can remember enjoying themselves, or more generally about feelings of sadness or low mood."


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