RESEARCH - Depression in scleroderma: a missed opportunity

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Depression in scleroderma: a missed opportunity

Rheumawire

Jan 19, 2005

Gandey

ton, SC - Patients with systemic sclerosis and declining functional

status or gastrointestinal problems are more likely to develop depression, a

new study shows. The report, published in the January 2005 issue of the

Journal of Rheumatology, demonstrates that despite this trend, few patients

are prescribed antidepressants [1].

" In our population, only 19% of patients classified as having high

depression scores were currently on antidepressants, " Dr Nietert

(Medical University of South Carolina at ton) told rheumawire. " A lot

of the time, specialists such as rheumatologists are so focused on the

medical condition of their patients that they miss the opportunity to help

them with the psychological challenges that come with their diseasean aspect

that has a strong correlation to quality of life, " Nietert said.

" Rheumatologists need to wake up to the fact that a lot of their systemic

sclerosis patients are depressed. They need to work with primary-care

physicians and do a better job of treating depression. "

Nietert and his team point out that although systemic sclerosis is typically

characterized by skin thickening and abnormal fibrotic processes affecting a

wide variety of organ systems, including the lungs, esophagus and other

portions of the gastrointestinal tract, kidneys, heart, and digital blood

vessels, the disease also has significant effects on psychological health.

Previous studies estimate that about 17% of patients with systemic sclerosis

suffer moderate to severe depression, a finding comparable to that among

patients with other chronic diseases.

The researchers note that comorbid depression can have an important negative

effect on patients with chronic illnesses, including a worsening of physical

symptoms and increased mortality rates. They add that depression also

contributes significantly to lost work days and numbers of bed days.

Looking at 72 systemic sclerosis patients from a university hospital's

rheumatology clinic, Nietert and colleagues investigated whether demographic

and clinical factors are associated with comorbid depression. Study

participants completed 3 questionnaires:

The Center for Epidemiologic Studies Depression (CES-D) scale, an

abbreviated version of a functional status instrument.

The Scleroderma Health Assessment Questionnaire.

The Gastrointestinal Quality of Life Index.

Nietert and colleagues calculated correlations among scores on the

questionnaires and, using stepwise linear regression, established

associations between CES-D scores and a variety of demographic and clinical

characteristics.

They found that higher levels of depression were independently associated

with lower levels of education (p<0.01), worse upper-GI tract functioning

(p=0.019), worse functional status (p=0.34), current corticosteroid use

(p=0.061), and cardiac involvement (p=0.086).

" This study confirms the observation that depressive symptoms are quite

common among patients with systemic sclerosis. Analysis of CES-D scores

indicates that 36.1% of these patients are likely to have clinically

relevant depression, " the researchers write. " Although this report

identifies variables that are significantly associated with depression among

systemic sclerosis patients, we do not suggest that the factors are causal. "

Nietert and colleagues point out a number of limitations to their work. They

question how generalizable their results might be, given the study focused

on patients from a university hospital. They add that the response rate for

the questionnaires was only moderate (58%), and they did not factor in a

variety of other measures commonly associated with depression such as social

support and disease coping mechanisms.

But despite these factors and given the relatively infrequent use of

antidepressant medications in this study sample, the researchers call for

more aggressive treatment of depression. They recommend a combination of

health education, counseling, and antidepressant treatment.

Source

Nietert PJ, HC, Bolster MB, et al. Correlates of

depression, including overall and GI functional status among patients with

systemic sclerosis. J Rheumatol 2005; 32:51-57.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org