Anxiety, Depression Common Among Patients With Lupus Nephritis

Patients with lupus nephritis experienced significant levels of depression and anxiety, which worsened quality of life and negatively impacted disease activity, according to a study published in Indian Journal of Psychiatry.¹ Investigators believe screening for these psychological conditions coupled with early diagnosis may improve health-related outcomes in this patient population.

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A lupus nephritis diagnosis, as with all chronic diseases, can lead to anxiety and depression which can impact disease-related factors such as disease activity, disease duration, and treatment adherence. These variables may impact the quality of life and disease management among these patients. Previous research has indicated approximately 60% of patients with lupus are affected by feelings of depression, anxiety, anger, guilt, fear, or sadness.²

“Lupus is an autoimmune disease that affects multiple body systems and requires long-term treatment,” wrote lead investigator, Ritambra Dadwal, nursing tutor at the Institute of Nursing, University Regional Centre, Shri Goindwal Sahib, India, and colleagues. “The multisystem effect of this disease and long treatment may cause anxiety and depression in patients with lupus nephritis and ultimately deteriorate their quality of life and also affects the activity of the disease.”

A descriptive cross-sectional study evaluating anxiety, depression, and quality of life in patients with lupus nephritis was conducted to assess their relationship with disease activity. Investigators used a total enumerative technique to recruit 100 patients with lupus nephritis from a nephrology outpatient department in India.

Information was collected via telephone from July 2020 to February 2021. Exclusion criteria included pre-existing mental illness, visual or hearing impairment, and patients aged <18 years. Assessments included the Generalized Anxiety Disorder-7 (GAD-7) item scale, the lupus quality of life (lupus-QoL) questionnaire, Patient Health Questionnaire-9 (PHQ-9), the systemic lupus erythematosus disease activity index (SLEDAI), and a socio-demographic profile sheet.

Among study patients, the mean age was 33.75 years, the mean disease duration was 72.21 months, 89% were female, most (69%) were married, and 92% were not smokers. Most (81%) patients had comorbidities, with the most common being hypertension (51%), followed by hypothyroidism (15%), type 2 diabetes mellitus (6%), and tuberculosis (5%). All patients were taking an immunosuppressant.

Most (60.0%) patients with lupus nephritis reported moderate anxiety and 61.0% had moderate depression which impacted their disease activity and quality of life. A third (33%) of patients reported mild anxiety, 5% had severe anxiety, and 2% reported minimal anxiety. Similarly, 30% reported mild depression and 7% had moderately severe depression.

A deterioration in quality of life in this patient population due to their disease was observed using the lupus-QoL questionnaire. Domains of the lupus-QoL that had a significant association with the SLEDAI were physical health, emotional health, body image, pain, intimate relationships, planning, and being a burden to others. Depression, anxiety, and SLEDAI were also significantly linked.

Investigators noted limitations including performing the study in a single institution, which may have hindered the generalizability of the findings. Further, interactions between investigators and patients were limited due to collecting data via telephone because of the COVID-19 pandemic. Lastly, the study is subject to recall bias as respondents were asked several questions related to life events that happened in the past.

“Patients with lupus nephritis suffer from psychological disorders such as anxiety and depression due to the chronicity and severity of their illness,” investigators concluded. “Though such disorders were quantified as moderate, they had a significant negative impact on quality of life and disease outcomes.”

References

1. ^{Dadwal R, Pathak P, Subbiah A, Dahiya U. Impact of anxiety and depression on disease activity and quality of life in patients with lupus nephritis. Indian J Psychiatry. 2023;65(4):460-464. doi:10.4103/indianjpsychiatry.indianjpsychiatry_626_22}
2. ^{Azizoddin DR, Zamora-Racaza G, Ormseth SR, Sumner LA, Cost C, Ayeroff JR, et al. Psychological factors that link socioeconomic status to depression/anxiety in patients with systemic lupus erythematosus. J Clin Psychol Med Settings 2017;24:302–15}