Background Chronic dermatologic diseases in general and cutaneous involvement in patients with systemic lupus erythematosus (SLE) in particular have been linked to increased depression. However, little is known about the burden of depression and its risk factors in patients with primary chronic cutaneous lupus erythematosus (CCLE), the most common type of cutaneous lupus. Additionally, previous studies examining CCLE have included predominantly white patients, despite recent findings indicating that black individuals have higher susceptibility for this condition and experience earlier damage in the disease course. We aimed to examine the prevalence of depression in patients with primary CCLE in the Southeast U.?S and explore sociodemographic, healthcare, and disease-related factors that can impact the risk of depression in this cohort.
Methods We conducted a cross-sectional study in a predominantly African American cohort of patients with primary CCLE from the Southeast U.S. Participants were assessed about depression, skin-related quality of life, sociodemographic and healthcare factors using validated self-reported tools. Depression was assessed using the PROMIS depression short form 8a. We conducted Student-T test and ANOVA to examine the severity of depression symptoms across sociodemographic subgroups, and we further explored factors associated with depression using univariate and multivariate analyses.
Results Among 106 patients with a documented diagnosis of primary CCLE, 28 (26.4%) had moderate to severe depression. The univariate analysis showed that being employed and insured, reporting higher social support, visiting a primary care physician in the last year, and reporting better physician-patient communication protected against depression. Patient’s perceptions of staff disrespect and greater burden of the skin condition on patient’s quality of life corresponded with higher risk. In the multivariate analysis, staff disrespect and emotional support were the only factors that increased and reduced the odds of depression, respectively (Staff disrespect: OR 2.35 [95% CI 1.06 to 5.17] per 1-unit score increase; emotional support: OR 0.48 0.35–0.66] per 5-unit score increase).
Conclusions Patients with isolated CCLE experience higher rates of depression than the general population. This population may uniquely benefit from routine mental health care such as depression screening and management. Moreover, office staff can undergo educational sessions to ensure fair treatment of all patients, and clinical tools may be implemented to assess patients’ emotional support and initiate referral to care-coordinators, support groups, primary care and psychotherapy or psychiatric care as needed.
Acknowledgements This study is supported by the Centers for Disease Control and Prevention (CDC) Grant 1U01DP005119.
The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the CDC.
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