Adjustments made for health-related behaviors, including cigarette smoking, body mass index, oral contraceptive use, menopause or postmenopausal hormone use, alcohol use, exercise and diet only slightly attenuated these findings.
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“Our study contributes to evidence that depression increases the risk for SLE and other autoimmune diseases,” says lead investigator Andrea Roberts, PhD, research scientist in the department of Environmental Health at Harvard T.H. Chan School of Public Health, Boston. “We found many health-related behaviors, such as exercise, diet and smoking, did not explain most of the increased risk. We take this as evidence there may be direct biological effects of depression that increase the risk of autoimmune disease, for example, via inflammation.”
Study Results at a Glance
The study’s data were collected from two cohorts of women participating in the Nurses’ Health Study (1996–2012) and the Nurses’ Health Study II (1993–2013) and were analyzed from August 2017 to May 2018.
SLE was classified as patients meeting four or more of the 11 ACR criteria, which were confirmed by medical record review, according to senior investigator Karen Costenbader, MD, MPH, rheumatologist and Lupus Program director at Brigham and Women’s Hospital, Boston. Depression was assessed according to three indicators: a clinician’s diagnosis of depression, regular antidepressant use or a score of less than 60 on the five-item Mental Health Inventory.
Cox proportional hazards regression models were used to estimate risk of SLE among study data for 194,483 women (age 28–93; 93% white) during 20 years of follow-up. SLE occurred in 145 women. Compared with women with no depression, women with a depression history displayed a subsequently higher risk of developing SLE.
Depression as a Sign of SLE
It’s not uncommon for patients living with chronic conditions, such as SLE and other rheumatic diseases, to experience depressive symptoms, including sadness, loneliness or despair. Separate research suggests that 25% of lupus patients experience major depression and 37% experience major anxiety.2
“We suggest clinicians be aware that depression is linked to an increased risk of autoimmune disease. So in women with depression, screening for family history of autoimmune disease and symptoms of autoimmune disease may be warranted,” Dr. Roberts says.
She also recommends rheumatologists make time to speak with SLE patients about possible symptoms of depression so these patients can be connected with mental health providers if needed.