Review examines prevalence of depression in SSc patients

Findings: Education, marital status may affect symptoms

Margarida Maia, PhD avatar

by Margarida Maia, PhD |

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An illustration shows a person lying on a bench, possibly experiencing symptoms of depression.

Having a higher level of education or being married may mean fewer symptoms of depression for people with systemic sclerosis (SSc), according to a systematic review of multiple studies.

Researchers also observed that lung involvement, breathing problems, and tender joints were linked to more symptoms of depression, but not anxiety.

Because there was not much evidence available, “future studies should examine prevalence of mood and anxiety disorders in SSc in large, representative samples,” the researchers wrote.

The systematic review, “Results from a living systematic review of the prevalence of mood and anxiety disorders and factors associated with symptoms in systemic sclerosis,” was published in the journal Scientific Reports.

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People with SSc experience a wide range of symptoms caused by a buildup of scar tissue in the skin and possibly internal organs such as the heart, lungs, kidneys, and intestinal tract.

“Disease presentation is extremely heterogeneous, and its course is unpredictable,” the researchers wrote. Because they are unsure of how their disease will progress, many people with SSc experience changes in mood or begin to feel anxious.

Also contributing to mood and anxiety disorders are “high levels of chronic pain, fatigue, body-image distress, overall disability, increased risk of mortality, and limited treatment options,” the scientists added.

Living systematic review

What is less known is how prevalent (common) mood and anxiety disorders are among people with SSc. To find information on this topic, three researchers in Canada launched a living systematic review, a summary of research studies that is updated regularly to include new evidence. For their first report, the researchers found six relevant studies in the literature.

Three studies looked at the prevalence of mood or anxiety disorders. Most (up to 88%) of the patients were women, and their mean age ranged from 42 to 58. Mean disease duration ranged from six to 10 years.

The prevalence of major depressive disorder, or clinical depression, in a current or past month ranged from 4% to 29% depending on the group of patients being studied (Canadian, Indian or French). The prevalence of lifetime major depressive disorder was higher (up to 59%).

The current or past-month prevalence of any anxiety disorder ranged from 49% to 51%, and that of generalized anxiety disorder, or persistent anxiety, ranged from 3% to 13%. Lifetime prevalence of anxiety was higher than 60% in the French group.

Obsessive-compulsive disorder, or recurring thoughts and behaviors that need to be repeated over and over again, occurred in up to 15% of the patients.

“The prevalence of mood and anxiety disorders appears to be high in SSc, but estimates vary widely,” the researchers wrote.

Three other studies (in the Netherlands, Canada, and the other study on Iranian patients) looked at factors that may be linked to symptoms of mood or anxiety disorders in people with SSc. Most (up to 89%) of the patients were women, and their mean age ranged from 39 to 56.

Mean disease duration ranged from eight to 11 years, and up to 55% of the patients had diffuse SSc, a form of the disease that affects large areas of the body and usually is more severe.

In two studies, having a higher level of education and being married or living as married were linked to less depression. In one study, lung involvement, breathing problems, and tender joints were linked to worse depression.

No link was found between symptoms of SSc and those of anxiety in the study that assessed factors associated with both depression and anxiety symptoms.

More studies needed

Overall, study limitations included small sample sizes and different clinical tools for assessment.

“Future research that uses semi-structured interview methods or commonly used and well-validated fully structured interviews and that include large numbers of representative patients are needed,” the researchers wrote.

“We will continue to update results as they become available via our living systematic review approach,” they concluded.