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Chronic Cutaneous Lupus Erythematosus: Depression Burden and Associated Factors
  • Published Date:
    Jun 2019
  • Source:
    Am J Clin Dermatol. 20(3):465-475
  • Language:
    English


Public Access Version Available on: June 01, 2020, 12:00 AM information icon
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Details:
  • Alternative Title:
    Am J Clin Dermatol
  • Description:
    Objective:

    Depression may occur in up to 30% of individuals with cutaneous lupus erythematosus (CLE), many of whom may also have systemic manifestations. Compared to acute and subacute, chronic cutaneous lupus erythematosus (CCLE) conditions are less likely to present systemic involvement, but more often cause permanent scarirng and dyspigmentation. Little is known, however, about depression in those who have CCLE confined to the skin (primary CCLE). As African Americans are at high risk for primary CCLE and depression, we aimed to investigate the prevalence and explore risk factors of depression in a predominantly Black population-based cohort of patients with primary CCLE.

    Methods:

    Cross-sectional analysis of a cohort of individuals with a documented diagnosis of primary CCLE, which is established in the metropolitan Atlanta. Participants were recruited from the Centers for Disease Control and Prevention (CDC) population-based Georgia Lupus Registry, multi-center dermatology clinics, community practices, and self-referrals. The Patient Reported Outcomes Measurement Information System (PROMIS) was used to measure the primary outcome: depressive symptoms. Stand-alone questions were used to assess sociodemographics and healthcare utilization. Emotional, informational, and instrumental support were measured with PROMIS short forms, interpersonal processes of care with the IPC-29 Survey, and skin-related quality of life with the Skindex-29+ tool.

    Results:

    Of 106 patients, 92 (86.8%) were female, 91 (85.8%) Black, and 45 (42.9%) unemployed or disabled. Twenty-eight (26.4%) reported moderate to severe depressive symptoms. Depression severity was lower in patients aged ≥60, married, or college-graduated. Univariate analysis showed that being employed (OR=0.24, 95% Confidence Interval (CI)=0.10-0.61), insured (OR=0.23, 95%CI=0.09-0.60), reporting higher instrumental, informational, and emotional support (OR=0.94, 95%CI=0.90-0.99; OR=0.91, 95%CI=0.87-0.95; and OR=0.86, 95%CI=0.81-0.92, respectively), visiting a primary care physician in the last year (OR=0.16, 95%CI=0.04-0.61) and reporting better physician-patient interactions (OR=0.56, 95%CI=0.37-0.87) were negatively associated with depression. Patient’s perceptions of staff disrespect (OR=2.30, 95%CI=1.19-4.47) and worse skin-related quality of life (OR=1.04, 95%CI=1.02-1.06) rendered higher risk. In multivariate analysis, only perception of staff disrespect (OR=2.35, 95%CI=1.06-5.17) and lower emotional support (OR=0.48, 95%CI=0.35-0.66) remained associated with depression.

    Conclusions:

    Over one quarter of a predominantly Black population-based cohort of individuals with primary CCLE reported moderate to severe depression, a rate 3 to 5 times higher than those described previously in the general population from the same metropolitan Atlanta area. Our findings suggest that while patient’ perceptions of discrimination in the healthcare setting may play a role as determinant of depression, social support may be protective. In addition to routine mental health screening and depression treatment, patients with CCLE and depression may benefit from interventions directed to provide emotional support and improve office staff interpersonal interactions.

  • Subject:
  • Pubmed ID:
    30877492
  • Pubmed Central ID:
    PMC6534449
  • Document Type:
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