Systematic review and meta-analysis of mental health conditions in patients with SLE

Mental health conditions (MHCs) are prevalent among patients with systemic lupus erythematosus (SLE) across age groups. However, it remains unclear whether MHCs are associated with an increased risk of SLE or influence the subsequent outcomes of the disease.

Liu X et al.¹ recently published an article in Rheumatology (Oxford) sharing a systematic review and meta-analysis to estimate the pooled prevalence of MHCs in patients with SLE and their association with risk and outcomes of the disease. Here, we summarize their key findings.

Methods¹

• Studies published before 2023 were searched in PubMed, Web of Science, and EMBASE.
• Prevalence of MHCs were pooled separately for two age groups (adults aged ≥18 years vs children aged <18 years) and then according to outcome measures within each category.
• Using random-effect models, pooled prevalence and risk ratios were calculated for each MHC.

Key findings¹

• Of 203 identified studies (N = 1,485,094), 189 studies (12 studies among children and 177 in adults) evaluated the prevalence of MHCs in patients with SLE.

Prevalence of MHCs among patients with SLE

• Among adults with SLE, the most prevalent mental disorders were cognitive impairment, mood disorder, and depressive disorder, while the most prevalent mental health symptoms were sleep disturbance, anxiety symptoms, and cognitive dysfunction (Figure 1A).
• Among children with SLE, the most prevalent mental disorder and mental health symptom was cognitive impairment and dysfunction, respectively (Figure 1B).

SLE, systemic lupus erythematosus.
*Data from Liu X, et al.¹

 Association between pre-existing MHCs and the risk of SLE

• Eight cohort studies (N = 1,316,921 adults) reported association of MHCs prior to SLE diagnosis and the risk of SLE.
• Five studies reported that post-traumatic stress disorder was associated with a higher risk of SLE (risk ratio = 1.93; p < 0.001).
• Two studies demonstrated that depressive disorder was associated with an increased incidence of SLE (risk ratio = 2.30; p < 0.001).
• One study showed association between all types of sleep disorders and increased risks of SLE.

MHCs and patient outcomes of SLE

• Seven studies reported associations between MHCs and clinical outcomes in patients with SLE.
• Depressive symptoms were associated with adverse outcomes, including a higher risk of unemployment and subclinical atherosclerosis, and decreased health-related quality of life.
  • Anxiety showed no significant association with progression of SLE disease activity.
• Clinically diagnosed mental disorders were found to increase intensive care unit admissions over time and suicidal drug overdoses.

Key learnings1

This study showed that MHCs are highly prevalent among patients with SLE across age groups and are significantly associated with increased risk of SLE and disease outcomes. Comprehensive treatment approaches for SLE should encompass thorough evaluation and prevention of MHCs. This includes early screening and intervention for cognitive impairment in both adults and children with SLE and management of sleep disturbances in adults with SLE. Future research is warranted to investigate the role of serological markers and their associations with MHCs in patients with SLE.