Presentation: Prevalence and Clinical Correlates of Symptoms of Depression in Patients with Systemic Sclerosis (2007)

5 Prevalence and Clinical Correlates of Symptoms of Depression in Patients with Systemic Sclerosis

: A recent systematic review found that the prevalence of clinically significant symptoms of depression was 46% - 65% in 8 studies of patients with systemic sclerosis (SSc) and that these rates were high compared to other medical patient groups assessed with the same instruments and cutoffs. Small sample sizes and methodological issues, however, limited the ability to draw conclusions about predictors of depressive symptoms in SSc patients (Thombs et al., Arthritis Care & Research, in press). The objective of this study was to assess the prevalence and predictors of symptoms of depression in a large pan-Canadian sample of patients with SSc.
Methods: A cross-sectional sample of 376 SSc patients in the Canadian Scleroderma Research Group Registry from 15 centers. Patients were assessed with the Center for Epidemiological Studies Depression Scale (CES-D) and through extensive clinical histories and medical examinations. Rates of significant symptoms of depression were based on the standard CES-D cutoff of 16 or higher and on a cutoff of 19 or higher that has been found to be more accurate among patients with chronic rheumatic disease. Hierarchical multiple linear regression was used to assess the relationship between sociodemographic and clinical variables with symptoms of depression.
Results: The sample was 87.2% female and 80.6% White with a mean age of 55.4 years. Slightly less than half (45.7%) of the sample completed more than high school education, and 72.6% were married. Mean time since onset of non-Raynaud’s symptoms was 10.8 years and from diagnosis of SSc was 8.6 years; mean modified Rodnan Total Skin score was 11.2; 48.2% of the sample had diffuse SSc. The percentages of patients who scored ≥ 16 and ≥ 19 on the CES-D were 35.1% and 25.5%, respectively. Patients with less education (β = 0.15, P = 0.001), patients who were not married (β = 0.16, P < 0.001), patients with higher physician-rated overall disease severity (β = 0.14, P = 0.013), and patients with more tender joints (β = 0.10, P = 0.033), more gastrointestinal (GI) symptoms (β = 0.21, P < 0.001), and more difficulty breathing (β = 0.24, P < 0.001), had significantly higher total CES-D scores. As a group, specific symptom indicators (tender joints, GI symptoms, breathing) predicted the most incremental variance in depressive symptoms (ΔR2 = 14.2%, P < 0.001) despite being added to the model after demographic, socioeconomic, and global disease duration/severity indicators.
Conclusion: High levels of depressive symptoms are common in patients with SSc and are related to overall SSc disease severity, as well as specific medical symptoms. Screening for depression among patients with SSc is recommended, although more research is needed to determine the best method for doing this. Successfully treating dypsnea, gastrointestinal symptoms, and joint pain may improve mood, although this has not yet been demonstrated.

 B.D. Thombs, None; M. Hudson, None; S.S. Taillefer, None; M. Baron, None.