Several studies have shown that anxiety and depression are more common in people with systemic lupus erythematosus (SLE), but a new study suggests that these mental disorders are even more common in people with lupus nephritis (LN).
Co-authors Ying Hu, PhD, First Affiliated Hospital of Harbin (China) Medical University, and Ge Zhan, PhD, First Specialized Hospital of Harbin, said that NL remains a serious and potentially fatal complication of SLE, with up to 30% of people with LN go on to develop end-stage renal disease (ESRD). Furthermore, they said it is not uncommon for people with NL to experience anxiety, depression and suicidal tendencies, all of which can affect treatment success and quality of life.
Previous studies have suggested that between one-third and one-half of people with SLE suffer from anxiety and/or depression. But Hu and Zhan said there is limited evidence to describe the rates of these disorders among people with NL.
In their new study, published in the journal Immunity, Inflammation and Disease, the 2 investigators outlined findings from the case-control study, in which they compared 3 cohorts of 50 patients: 1 cohort of people with SLE and LN, 1 cohort of people with SLE without NL and 1 cohort of healthy controls. All participants were assessed using the Hospital Anxiety and Depression Scales for anxiety (HADS-A) and depression (HADS-D). The researchers then compared the rates to see whether LN increased the odds of anxiety or depression.
The answer, based on these participants, seemed to be “yes”. On the HADS-A, the median score among people with LN was 7.0, with an interquartile range of 6.0-10.0. On HADS, scores of 7 and below are considered normal; scores of 8-10 represent borderline or mild cases. For people with non-LN SLE, the median score was 6.0. For the control group, the median score was 5.0. The anxiety rate based on these scales was 38.0%, 28.0% and 12.0% for people with SLE with LN, SLE without LN and healthy controls, respectively.
Depression scores were even higher. The median HADS-D score for people with SLE and LN was 7.5, with an interquartile range of 6.0-11.0. The median score for people with SLE without LN was 6.0, and the median score for the control group was 4.0. The authors found a depression rate of 50% in the SLE with LN group, 30.0% in the non-LN SLE group and 10.0% in the control group.
The investigators said that possible reasons for the higher rates of anxiety and depression in people with NL could be that people with NL may be more likely to experience events such as pain, disability, discrimination and social stress, or that NL brings with it the recruitment of pro-inflammatory cytokines that can potentially increase the risk of anxiety and depression.
In the study, age, LN Activity Index score, alopecia, 24-hour proteinuria, and C-reactive protein were all independently correlated with a higher risk of anxiety. Only 2 of these factors – age and LN activity index – were associated with a higher risk of depression.
The authors said their study was limited in size and also did not attempt to investigate the underlying pathogenesis of anxiety and depression in these patients. More studies will be needed to explore the pathogenesis of the conditions, Hu and Zhan said.
Still, they concluded that these data suggest that anxiety and depression are a significant concern for people with SLE, and particularly for those with LN and SLE.
Hu Y, Zhan G. Prevalence of anxiety and depression and their risk factors in patients with lupus nephritis: a case-control study. ImmunInflamm Dis. 2022;10(9):e689. doi:10.1002/iid3.689