How Are Sicca Signs and Symptoms Associated With Depression Among Men Classified With and Without Sjögren Disease?

ABSTRACT

PURPOSE: Sjögren disease (SjD) cohorts represent rich resources to study associations between dry eye/mouth (sicca) signs/symptoms and depression. Because SjD affects mainly women, little is known about men with sicca signs/symptoms and associations with depression. The Sjögren's International Collaborative Clinical Alliance contained many men allowing for studying associations between sicca signs/symptoms and depression. We hypothesized that sicca symptoms would be positively associated with depression in males. DESIGN: Cross-sectional study. METHODS: At baseline, participants completed questionnaires and underwent ocular and oral examinations. Depression was assessed using the Patient Health Questionnaire-9. Logistic regression models were used to identify associations between depression and SjD diagnostic criteria and sicca symptoms. RESULTS: Of 309 males, 98 were classified as SjD, whereas 198 were classified as non-SjD. We found that having a labial salivary gland biopsy with focus score ≥1 foci/mm2 was associated with a lower odds of being classified as depressed (odds ratio [OR] 0.36, 95% CI 0.18-0.73, P = .01). Having positive anti-Sjögren syndrome antigen A antibody was associated with lower odds of being classified as depressed (OR 0.44, 95% CI 0.23-0.88, P = .02). Higher odds of depression were found with ocular burning (OR 3.16, 95% CI 1.74-5.73, P < .001), light sensitivity (OR 2.59, 95% CI 1.48-4.55, P = .001), and complaints of dry mouth (OR 4.58, 95% CI 1.54-13.63, P = .006). CONCLUSION: Ophthalmologists should be specific when inquiring about ocular discomfort (focusing on burning and light sensitivity) and consider querying about depression and/or providing mental health resources to those who endorse such qualities.