Nurses' Health Study: depression history linked to SLE onset

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Takeaway

  • Women with a history of depression may have a >2-fold risk of developing systemic lupus erythematosus (SLE).

Why this matters

  • Findings add to a growing body of evidence linking depression and SLE.
  • Treatment for depression may cut the risk for SLE.

Study design

  • Nested case-control within 2 prospective cohorts (n=194,483) consisting of the Nurses' Health Study (NHS) (1996-2012) and the NHSII (1993-2013).
  • History of depression was defined by antidepressant use, clinician diagnosis of depression, or "probable depression" score on the 5-item Mental Health Inventory.
  • SLE was defined by self-report of ≥4 American College of Rheumatology criteria and was confirmed by medical record review.
  • Funding: National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Key results

  • 145 cases of SLE were identified over 20-year follow-up.
  • Women with a history of depression were at increased risk for SLE vs women with no history (HR, 2.67; P<.001>
  • The association was only slightly attenuated (adjusted HR, 2.45; P<.001 by adjusting for bmi cigarette smoking oral contraception and postmenopausal hormone use.>
  • The depression-SLE association remained strong when depression status was lagged by 4 years with respect to SLE onset (HR, 1.99; 95% CI, 1.32-3.0).
  • Limitations

    • Nurses were healthier than the general population and were mostly white, thereby limiting generalizability.
    • Potential for misclassification of depression history.