Risk factors for depression in systemic lupus erythematosus: a systematic review and meta-analysis

Depression is highly prevalent among patients with systemic lupus erythematosus (SLE) and is associated with adverse clinical outcomes. However, evidence on its risk factors remains inconsistent, limiting early identification and targeted intervention.

We conducted a systematic review and meta-analysis in accordance with PRISMA and MOOSE guidelines. Eight databases were searched from inception to May 2024 for observational studies reporting risk factors for depression in adult SLE patients assessed by validated scales. Study quality was evaluated using the Newcastle-Ottawa Scale or AHRQ criteria. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models.

A total of 26 studies (n = 8,960 patients) were included. Significant risk factors for depression included economic hardship (OR = 6.05, 95% CI: 3.64-10.07), high-dose glucocorticoid use (OR = 7.72, 95% CI: 4.62-12.90), higher disease activity (OR = 3.15, 95% CI: 2.95-3.37), unemployment (OR = 3.06, 95% CI: 1.48-6.32), lower academic qualifications (OR = 2.21, 95% CI: 1.45-3.36), presence of comorbidities (OR = 2.20, 95% CI: 1.45-3.34), smoking (OR = 3.17, 95% CI: 1.44-6.99), and greater fatigue severity (per unit increase: OR = 1.23, 95% CI: 1.08-1.40). Younger age was also associated with higher depression risk (OR = 1.97, 95% CI: 1.41-2.76). Subgroup and meta-regression analyses revealed substantial heterogeneity across studies, partially explained by geographic region and depression assessment tools. Publication bias was detected but did not alter core findings in sensitivity analyses.

This meta-analysis identifies key clinical, demographic, and psychosocial risk factors for depression in SLE. Findings support integrating routine depression screening with holistic assessments of disease burden and social context in clinical practice, particularly within nursing-led care models.

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024557892, identifier CRD42024557892.