Trajectories of depressive symptoms in systemic lupus erythematosus over time.

ABSTRACT

OBJECTIVES: The objectives of this study were to determine the trajectories of depressive symptoms in patients with SLE and to identify baseline characteristics that are associated with a patient's trajectory of depression. METHODS: Data from the Lupus Outcomes Study at the University of California, San Francisco were analysed. Depressive symptomatology was assessed in years two through seven using the Center for Epidemiologic Studies Depression Scale (CES-D), with higher scores representing more severe depressive symptoms. Group-based trajectory modelling was used to determine latent classes of CES-D scores over time. Ordinal logistic regression analyses were performed to identify baseline characteristics associated with worse classes of depressive symptoms. RESULTS: CES-D scores for 763 individuals with SLE over 6 years were mapped into four distinct classes. Class 1 (36%) and class 2 (32%) comprised the largest proportion of the cohort and were defined by the lowest and low CES-D scores (no depression), respectively. Class 3 (22%) and class 4 (10%) had high and the highest scores (depression), respectively. Greater age [odds ratio (OR) 0.97, 95% CI 0.96, 0.99] and higher education level (OR 0.79, 95% CI 0.70, 0.89) at baseline were associated with lower odds of membership in worse classes of depressive symptoms. Conversely, lower income (OR 1.73, 95% CI 1.03, 2.92), worse SF-36 physical functioning scores (OR 1.12, 95% CI 1.12, 1.13) and worse SF-36 bodily pain scores (OR 1.58, 95% CI 1.55, 1.61) were positively associated with membership in worse classes of depressive symptoms. CONCLUSION: Four classes of depressive symptoms were identified in patients with SLE. Understanding the trajectories of depressive symptoms and the associated risk factors can aid in the management of these symptoms in individuals living with SLE.