Association of depressive/anxiety symptoms with quality of life and work ability in patients with systemic lupus erythematosus

Objective To study the association of depressive/anxiety symptoms with health-related quality of life (HRQoL) and work ability in Chinese patients with systemic lupus erythematosus (SLE). Methods Consecutive patients with >= 4 ACR criteria for SLE were recruited. Depressive and anxiety symptoms were assessed by the Hospital Anxiety and Depression scale (HADS). HRQoL was assessed by the Chinese version of MOS-Short Form (SF)-36. Disease activity of SLE was assessed by the SLE disease activity index (SLEDAI) and organ damage was assessed by the ACR/SLICC damage index (SDI). The relationship between HAD scores, work ability and HRQoL was studied. Results A total of 367 SLE patients were studied (95% women; age 40.2+/-12.9 years; disease duration 9.3+/-7.2 years). Fifty-five (15%) patients had HADS-depression score >= 10 and 70 (19%) patients had HADS-anxiety score >= 10. Patients with either score >= 10 had significantly lower SF36 score (physical and mental component) than those with score <10. In separate linear regression models, the mental and physical component scores of SF36 were significantly associated with the HAD-depression and HAD-anxiety score after adjustment for age, sex, SLE duration, years of education, religious belief, marital status, employment status, poverty, SDI and mean SLEDAI score in the preceding year. Among those who were working in the preceding year (n=190), 30 (16%) patients either quitted their job (n=22) or reduced working hours (n=8). Patients with work disability had significantly higher HAD-depression score than those without (6.31+/-5.51 vs. 3.93+/-3.72; p=0.03). Conclusion Depressive/anxiety symptoms were fairly common in SLE patients and independently associated with poorer HRQoL. Patients with more depressive symptoms were more likely to experience work disability.