The researchers also considered “other factors potentially associated with depression risk,” she says. “Older age, physical function, higher disease activity and a history of smoking were also associated with an increased risk of depression. Disease activity demonstrated a particularly strong correlation with depression, which again could be due to biologic effects of lupus on the brain, the stress of living with active lupus, poor medication adherence among depressed individuals or most likely a combination of factors.”
Another interesting finding: “The increased risk of depression in individuals with childhood-onset lupus was seen even after accounting for disease duration and activity,” Dr. Lawson says. “It seems there is something about the connection between the early onset of lupus and depression risk that is not just about the disease activity or duration. When it comes to depression, there’s something different about adults with lupus who have had this disease since they were kids.”
Andrea Knight, MD, is an assistant professor of pediatrics at the University of Pennsylvania Perelman School of Medicine in Philadelphia, a CHOP faculty member, and a co-author of the study. Dr. Knight’s work is targeted toward improving mental healthcare for children and adolescents with lupus.
“We know from other work that depression can impact medication adherence and healthcare utilization,” Dr. Knight says. “And the fact that physical functioning was lower and disease activity was higher in those with an increased risk of depression is telling. Further research is needed before we can tell exactly what direction things are going; in other words, is the depression causing decreased functioning (e.g., poor medication compliance, more disease), or is it the reverse. But the fact that it is highly associated means it is imperative we address the depression.”
Raising the alarm, Dr. Knight says, “Another study I was involved with examined how many pediatric rheumatology sites in North America have a social worker or a psychologist. The results were dismal—only one of three sites had a professional affiliated with their division. This should give us pause [because] here is a patient population with known mental health needs. We can’t leave these patients and their families without the resources they need. This work will help us go forward and investigate how to design interventions to best support those in need.”
‘The most startling thing was the strong association we found between educational attainment & depression.’ —Dr. Lawson
Family Matters
“When children are diagnosed with lupus in the early adolescent years, the family involvement factor is still a major consideration,” Dr. Knight says. “The more that parents and/or caregivers can create a supportive environment, the better children fare with this complex disease. The family’s socioeconomic, educational and emotional health status are all important in maximizing their ability to coordinate the young person’s care.”
