Depression among girls with lupus

Lupus Foundation of America

Resource Content

What is the topic?

Lupus in children tends to be more severe and its treatment can result in a wide variety of side effects that have implications for both physical and social life aspects. Steroid treatment, in particular, can result in side effects such as weight gain and rashes, which can have psychological effects.

What did the researchers hope to learn?

The researchers hoped to learn whether girls with lupus experience depression and/or a decline in positive body image.

Who was studied?

The study included 84 children with lupus and 80 healthy children. All children were 10-18 years old.

How was the study conducted?

Children were recruited to the study from the Pediatric Department of Peking Union Medical College Hospital in Beijing, China from April 2010 to December 2011. Children were excluded from participation in the study if they had been diagnosed with lupus in the preceding three months, were older than 18 years at the time of lupus diagnosis, or had difficulties in understanding or completing the required questionnaires. Healthy children matched by age and gender were recruited for participation from a nearby middle school.

The children were assessed by a pediatric rheumatologist to determine demographic characteristics, lupus-related measures, information about drug treatment regimens, and hospital admissions. The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) was used to determine lupus disease activity.

Possible depression was assessed with use of the Children Depression Inventory (CDI), a brief self-reported measures that helps assess cognitive, affective, and behavioral signs of depression in children 7-18 years old. Appearance concern was assessed with use of the physical appearance domain of the Self-Perception Profile for Children (SPPC).

What did the researchers find?

The girls with lupus who participated in the study were, on average, 15 years of age and had lupus for an average of about 16 months. All of them were taking prednisone (15-60 mg/day) and about 70% of them were taking immunosuppressive drugs. Most of the girls had mild or moderate lupus disease activity. The healthy girls who participated in the study were of comparable age.

The girls with lupus showed significantly increased depressive symptoms, as compared to the healthy girls, as determined by the CDI. Additional analyses revealed that negative mood, negative self-esteem, and loss of pleasure contributed most significantly to these effects. In addition, over 90% of the girls with lupus felt unattractive due to their disease, as indicated by the SPPC. Overall, the girls with lupus scored significantly lower on the SPPC than the healthy girls. Additional analyses revealed that the following were significantly associated with depressive symptoms among girls with lupus: concern about appearance and age.

What were the limitations of the study?

First, the SPPC, which was used to evaluate concern for appearance among girls with lupus in this study, is a generic measure (i.e., is not a lupus-specific tool) and is therefore potentially less robust than a lupus-specific tool. Second, self-reported measures of depressive symptoms, such as the CDI used in this study, may not capture the full spectrum of depressive symptoms. Third, the direction of the relationship between depressive symptoms and appearance concern among the girls with lupus cannot be determined. It is possible that concern for appearance leads to depressive symptoms or vice versa. Lastly, boys were not included in the study, so it is unknown whether boys with lupus experience a similar set of disease-associated depressive symptoms.

What do the results mean for you?

Childhood and early adolescence can be a vulnerable period marked by increased attention to physical changes, especially for girls with lupus, who may experience side effects (such as obesity) from steroid treatments. Little research has focused on the emotions related to altered appearance among children with lupus. The results of this study suggest that such emotions may have psychosocial consequences that can negatively impact quality of life. Therefore, it may be useful for children with lupus to undergo psychosocial screening, such as for depression, as part of their routine care.

Appearance concern and depression in adolescent girls with systemic lupus erythematosus
Ji L, Lili S, Jing W, Yanyan H, Min W, Juan X, and Hongmei S.
Appearance concern and depression in adolescent girls with systemic lupus erythematosus. 
Clinical Rheumatology 2012 Sept 9.