Correlates of Depression, Including Overall and Gastrointestinal Functional Status, Among Patients with Systemic Sclerosis

PAUL J. NIETERT, HOLLY C. MITCHELL, MARCY B. BOLSTER, MARGARET Y. CURRAN, BARBARA C. TILLEY, and RICHARD M. SILVER

ABSTRACT.

Objective. Patients with systemic sclerosis (SSc) may develop psychological problems in addition to physiologic symptoms. We investigated whether demographic and clinical factors are associated with comorbid depression.

Methods. From a university hospital's rheumatology clinic, 72 SSc patients who completed 3 questionnaires [Center for Epidemiologic Studies Depression (CES-D) scale, an abbreviated version of a functional status instrument, the Scleroderma Health Assessment Questionnaire (SHAQ), and the Gastrointestinal Quality of Life Index (GIQLI)] during an examination were recruited into the study. Correlations among scores on the 3 questionnaires [including upper and lower gastrointestinal (GI) tract subscales of the GIQLI] were calculated, and associations between CES-D scores and a variety of demographic and clinical characteristics were examined using stepwise linear regression.

Results. Higher CES-D scores (i.e., more depression symptoms) were significantly correlated with upper (r = –0.48, p < 0.0001) and lower (r = –0.41, p < 0.001) GI tract dysfunction and worse overall functional status (r = 0.51, p < 0.0001). Stepwise regression indicated 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).

Conclusion. Decreased functional status and abnormal GI functioning are significantly correlated with depression among patients with SSc. Other demographic and clinical indicators are also associated with depression. (J Rheumatol 2005;32:51-7)

Key Indexing Terms:

SYSTEMIC SCLERODERMA
DEPRESSION
GASTROINTESTINAL SYSTEM
QUALITY OF LIFE
HEALTH STATUS

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From the Department of Biostatistics, Bioinformatics, and Epidemiology and the Center for Health Care Research; and the Department of Medicine and Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA.

Supported in part by a grant (1 P60 AR049459-01) from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

P.J. Nietert, PhD, Department of Biostatistics, Bioinformatics, and Epidemiology and Center for Health Care Research; H.C. Mitchell, MD; M.B. Bolster, MD; M.Y. Curran, MD; R.M. Silver, MD, Department of Medicine and Division of Rheumatology and Immunology; B.C. Tilley, PhD, Department of Biostatistics, Bioinformatics, and Epidemiology.

Address reprint requests to Dr. P.J. Nietert, Center for Health Care Research, 135 Cannon Street, Suite 403, PO Box 250837, Charleston, SC 29425. E-mail: nieterpj@musc.edu

Submitted March 10, 2004; revision accepted August 26, 2004.

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