Association of Disease Activity and Cumulative Corticosteroid Exposure with Mental Health Outcomes in Patients with Systemic Lupus Erythematosus
TL;DR
Disease activity and cumulative corticosteroid exposure were significantly associated with mental health outcomes in patients with systemic lupus erythematosus and further studies are needed to clarify the causal relationships underlying these associations.
Abstract
Introduction: Mental health disorders, including depression, anxiety, and stress, are common among patients with Systemic Lupus Erythematosus (SLE) and may adversely affect disease outcomes. Disease activity and corticosteroid exposure have been proposed as important contributors to psychological disturbances. This study aimed to investigate the association between disease activity, cumulative corticosteroid dose, and mental health outcomes among female patients with SLE. Methods: A cross-sectional observational study was conducted among female SLE patients admitted to Haji Adam Malik General Hospital, Medan, Indonesia, between May and November 2024. Mental health outcomes were assessed using the Depression Anxiety Stress Scale-42 (DASS-42). Disease activity was evaluated using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). Univariable, bivariate, and multivariable analyses were performed using SPSS version 27 with a 95% confidence interval. Results: A total of 87 female patients with systemic lupus erythematosus (SLE) were included in this study, with a mean age of 31.8 ± 1.09 years. The mean cumulative corticosteroid dose was 4290.2 ± 459.1 mg, while the mean treatment duration was 24.8 ± 2.62 months. Based on SLEDAI-2K assessment, most participants exhibited mild-to-moderate disease activity (64.4%), whereas 12.6% and 16.1% had high and very high disease activity, respectively. Depression was identified in 54 participants (62.0%), anxiety in 64 participants (73.5%), and stress in 49 participants (56.3%). Bivariate analysis demonstrated significant correlations between cumulative corticosteroid dose, treatment duration, and SLEDAI-2K score with depression, anxiety, and stress levels (all p < 0.05). After adjustment for potential confounders, cumulative corticosteroid dose (p = 0.03) and disease activity measured by SLEDAI-2K (p = 0.001) remained independently associated with adverse mental health outcomes. Conclusion: Disease activity and cumulative corticosteroid exposure were significantly associated with mental health outcomes in patients with systemic lupus erythematosus. Further studies are needed to clarify the causal relationships underlying these associations.