Children with Lupus and Diabetes Are Likely to Also Have Depression

Children with systemic lupus erythematosus (SLE)/mixed connective tissue disease (MCTD) often suffer from significant bouts of depression and potentially suicide ideation, a study in the Journal of Pediatrics determined.

Although the rates of depression and suicide ideation are lower for patients with SLE than for children with Type 1 diabetes (T1D), the numbers are still high, and they reflect a need for not just condition-specific treatment but perhaps mental health support as well. According to the study authors, the risks of depression are particularly pronounced in certain racial and ethnic groups and with children suffering from long bouts of SLE/MCTD.

While the results, on the whole, are not surprising, some of the secondary and tertiary findings of the study are alarming. Among them was that depression was associated with poor disease control in both the SLE/MCTD group and the T1D group, and anxiety was closely associated with insulin pump use in subjects with T1D. This result mirrors a finding in adults in a 2014 study in Diabetes Care and several others. It also points to the cyclical nature of disease and co-morbid depression and suggests, as have many other studies, that treating depression can not only potentially improve quality of life, but can also be a substantial differentiator in both self-care and response to medical interventions.

The study looked at a cross section of 50 outpatient pairs of children, age 8 and above, matching subjects with SLE/MCTD and T1D by sex and age group. The researchers screened for depression, suicidal ideation, and anxiety using the Patient Health Questionnaire-9 and the Screen for Childhood Anxiety Related Emotional Disorders, respectively. They also collected parent-reported mental health treatment data and compared prevalence and treatment rates between subjects with SLE/MCTD and T1D.

Depression symptoms were present in 23% of participants and suicidal ideation was present in 15%. More than a quarter of participants struggled with anxiety. Compared with subjects with T1D, subjects with SLE/MCTD had lower adjusted rates of depression and suicidal ideation but poorer rates of mental health treatment (24% vs 53%).

The study adds to growing evidence that mental health care should be a primary concern for children with potentially long-term or chronic conditions. But despite evidence of comorbid depression associated with SLE and T1D, definitive research on this connection is still incomplete, particularly in children. The study authors hope this research leads to larger studies establishing the connection and suggesting appropriate avenues for clinical interventions.