Anxiety in childhood onset lupus: Longitudinal anxiety symptom screening

Abstract

Objective

Mental health conditions, including anxiety, are common in childhood onset systemic lupus erythematosus (cSLE) and impact disease management and quality of life. This study evaluates the prevalence of anxiety symptoms and association of anxiety screening results with baseline and longitudinal demographic, clinical, treatment, and social features in cSLE.

Methods

Patients ≥12 years of age diagnosed with cSLE were included. Demographic information, disease characteristics, disease activity, medications, provider-assessed medication adherence, and patient-reported outcomes of pain, physical function, anxiety, depression, suicidality and social determinants of health were extracted from the electronic health record. Anxiety symptoms, measured using the Generalized Anxiety Disorder (GAD) 7, were considered significant if score ≥10. The associations between GAD-7 scores and clinical, patient-reported, and social characteristics were evaluated longitudinally.

Results

Among 76 cSLE patients with 196 visits, 47% and 21% had at least one GAD-7 of mild, and moderate or severe anxiety, respectively. Baseline clinical features including history of lupus nephritis and glucocorticoid dose were not associated with GAD-7 scores. The Deprivation and Community Index, which estimates socioeconomic disadvantage within geographic areas, did not vary by anxiety status. In multivariate longitudinal analysis, there was an association with depression and clinically significant GAD scores.

Conclusion

Anxiety symptoms were common in this cohort of cSLE, and anxiety and depression were significantly associated. In multivariate longitudinal analysis, there was no association between anxiety and disease activity, steroid use, pain, physical function, or social factors. Results support the need for routine anxiety screening in children and adolescents with lupus.