Abstract
ObjectiveTo describe the prevalence of depression among patients with primary systemic vasculitides (PSV); compare prevalence according to vasculitis type and against controls; and examine the impact of depression on PSV outcomes.MethodsWe searched Medline, PubMed, Scopus and Web of Science using a predefined protocol in accordance with PRISMA guidelines. We included all studies that reported the prevalence or impact of depression in PSV. We also included polymyalgia rheumatica (PMR) given its association with giant cell arteritis (GCA). Meta-analyses of prevalence estimates were performed using random-effects models and reported as percentages (95% confidence interval).ResultsWe reviewed a total of 15 studies that described the prevalence of depression, categorised into small (n = 10) and large vessel vasculitis (n = 7). Pooled prevalence estimate for depression in a small vessel (predominantly ANCA-associated) vasculitis was 28% (95% CI 20–38%) with significant heterogeneity (I2 = 93%). Depression prevalence in large-vessel vasculitis (Takayasu and GCA/PMR) was 24% (95% CI 17–34%), again with significant heterogeneity (I2 = 96%). One study reported 56% prevalence of depression in medium vessel disease. The prevalence of depression in small vessel vasculitis was higher than healthy controls. In these patients, depression and depressive symptoms were associated with poorer quality of life, adherence, and work disability, but not disease activity or damage.ConclusionDepression is highly prevalent among patients with primary systemic vasculitis and associated with poorer outcomes across a range of measures in studies of small vessel disease. Further studies are needed for depression in medium and large vessel vasculitides.
Highlights
Primary systemic vasculitides (PSV) are a group of rare, chronic diseases characterised by inflammation of the blood vessels [1]
Not available; GPA, granulomatosis with polyangiitis; AAV, ANCA-associated vasculitis; GCA, giant cell arteritis; PMR, polymyalgia rheumatica; LVV, large vessel vasculitis; ICD, international classification of diseases code; HADS, Hospital Anxiety and Depression Scale; CESD, Center for Epidemiologic Studies Depression Scale; PHQ, Patient Health Questionnaire; Beck’s Depression Inventory (BDI), Becker’s Depression Inventory vessel vasculitis; most of these were ANCA-associated vasculitis (AAV) [8, 13,14,15,16,17,18,19,20]. (Brezinova et al reported results for small vessel vasculitis that were all AAV except one IgA vasculitis patient [18].) One study reported cerebral angiitis, which was included in the small vessel group [13]
Depression was highly prevalent among patients with primary systemic vasculitides
Summary
Primary systemic vasculitides (PSV) are a group of rare, chronic diseases characterised by inflammation of the blood vessels [1]. They can affect vessels of various size and type, with potential for irreversible organ damage and death. The potential for unpredictable, organ or life-threatening relapses will create significant psychological stresses. These factors can disrupt the life course with consequences on quality of life and mental health. Depression has the potential to directly impact PSV management, for example, through effects on treatment adherence [8]. Our aims were to (1) describe the prevalence of depression among patients with PSV, (2) compare prevalence according to vasculitis type and against controls, and (3) examine the impact of depression on PSV outcomes
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