Mental health conditions in patients with systemic lupus erythematosus: a systematic review and meta-analysis

Abstract

Abstract Objectives The reported prevalence of mental health conditions (MHCs) in people with systemic lupus erythematosus (SLE) ranges widely. Whether MHCs are associated with increased risk of SLE or the outcomes of the disease is unclear. This study aimed to conduct an umbrella and updated meta-analysis of MHCs in people with SLE and to identify whether MHCs are associated with the risk of SLE or patient outcomes. Methods We comprehensively searched PubMed, Web of Science and Embase databases to identify relevant studies published before June 2023. Random-effect models were used to calculate the pooled prevalence and risk ratios (RR) for each MHC. Results In total, 203 studies with 1 485 094 individuals were included. The most MHCs observed in patients with SLE were sleep disturbance (59.7% [95% CI, 52.4–66.8%]) among adults and cognitive dysfunction (63.4% [95% CI, 46.9–77.9%]) among children. We found that depressive disorders (RR = 2.30, 95% CI = 1.94–2.75) and posttraumatic stress disorder (RR = 1.93, 95% CI = 1.61–2.31) in the general population were significantly associated with an increased likelihood of developing SLE. Furthermore, concurrent MHCs were linked to unfavourable outcomes in patients with SLE, such as decreased quality of life, increased risk of unemployment and other somatic comorbidities. Conclusion Our study demonstrated a high prevalence of MHCs among patients with SLE. Individuals with pre-existing mental disorders exhibited an elevated susceptibility to developing SLE and patients presenting with MHCs were at increased risk of experiencing suboptimal health and functional outcomes. Therefore, evaluating and preventing MHCs should be considered as an integral component of the comprehensive treatment strategy for SLE.