Emotional Wellness Impacts Outcomes in Systemic Lupus Erythematosus

The high prevalence of mental health conditions among individuals with systemic lupus erythematosus (SLE) emphasizes the need for early screening, intervention, and tailored strategies to mitigate the impact of these conditions on patient outcomes, according to study results published in Rheumatology.

Systemic lupus erythematosus is a chronic autoimmune disorder characterized by the involvement of multiple organs and a diverse range of clinical symptoms. While it is known that SLE affects mental health, the prevalence and consequences of mental health conditions among patients with SLE are not well documented. Researchers conducted a systematic review and meta-analysis to determine the prevalence of mental health conditions among individuals with SLE and to assess the implications of these conditions on patient outcomes.

Cross-sectional, cohort, or case-control studies published before June 2023 that involved patients with SLE were eligible for analysis. Included studies provided sufficient data on mental health condition prevalence and associations with SLE, while using validated screening methods.

The definition of mental health conditions encompassed a variety of disorders (eg, depressive disorders, anxiety disorders, sleep disorders, etc) that were diagnosed according to standardized criteria, including the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases. Mental health symptoms were identified through validated screening instruments.

A total of 203 distinct studies were included in the systematic review. Among these, 189 studies investigated mental health condition prevalence, 8 studies explored their association with SLE risk, and 7 focused on the connection between mental health conditions and patient outcomes.

Mental health conditions were prevalent among both pediatric and adult patients with SLE, surpassing rates observed within the general population.

Among adults with SLE, cognitive impairment, mood disorders, and depressive disorders were the 3 most common mental health conditions, corresponding to prevalence rates of 27.0%, 27.0%, and 22.4%, respectively. Common mental health symptoms among adults included sleep disturbances (59.7%), anxiety symptoms (43.5%), and cognitive dysfunction (42.4%).

Cognitive impairment (55.4%) emerged as the most prevalent mental health condition among children with SLE, while cognitive dysfunction (63.4%) was the most prevalent symptom.  

Pre-existing mental health conditions, notably post-traumatic stress disorder (risk ratio [RR], 1.93; 95% CI, 1.61-2.31; P <.001) and depressive disorder (RR, 2.30; 95% CI,1.94-2.75; P <.001), were correlated with an increased risk of developing SLE among adults. A single study indicated that all types of sleep disorders were linked to an increased risk for SLE.

Mental health conditions, particularly depressive symptoms, were linked to adverse patient outcomes, including unemployment and diminished health-related quality of life.

Study limitations include unexplained heterogeneity and the small number of studies investigating the association between mental health conditions and patient outcomes.

The researchers concluded, “Individuals with pre-existing mental disorders exhibit an elevated susceptibility to developing systemic lupus erythematosus.”

This article originally appeared on Rheumatology Advisor