A systematic review of prevalence and predictors of depression in systemic sclerosis based on the CES-D, BDI, and PHQ- 9 self-assessment questionnaires.

Abstract

Objectives: This study aimed to investigate the prevalence of depression in Systemic Sclerosis (SSc) patients using depression self-assessment tools such as the Beck Depression Inventory (BDI), the Centre for Epidemiologic Studies Depression Scale (CES-D), and the Patient Health Questionnaire (PHQ-9) and to explore the clinical characteristics of SSc patients with depression and identify potential risk factors for depression.

Methods: Based on PRISMA guidelines, an electronic search was conducted in PubMed, Embase, PsycINFO, and Google Scholar to collect studies assessing systemic sclerosis and depression up to April 2024. Original research studies in SSc patients and depression using BDI > 10, CES-D > 16, and PHQ-9 > 10 that met our inclusion criteria were included and appraised using the Joanna Briggs Institute (JBI) instrument, then data extraction was performed.

Results: We identified 497 articles, of which 22 were included in this systematic review. Among the 4,165 patients who completed the self-assessment questionnaires, 1486 (35.6%) met the criteria for depression where 564 (31.9%) of patients were identified based on the CES-D, 410 (55.1%) from the BDI, and 512 (30.8%) from the PHQ-9 group. Gastrointestinal involvement was the most identified predictor for depression, while pain, disease activity, and pulmonary and joint symptoms of SSc were also commonly associated with depression. Non-SSc-related predictors of depression included unemployment, low educational level, and unmarried status.

Conclusion: Higher prevalence of depression is seen among patients with SSc. Although the prevalence varies according to the assessment tool used, we found correlation of depression estimates in SSc-patients between the CES-D and PHQ-9 scores. Moreover, this review identifies the significant predictors of depression in SSc patients and highlights the need of mental healthcare professionals to engage in the care of SSc patients.

Conclusion: HB level was significantly related to disease activity and structural damage in RA patients. Key Points • There is significant variability in estimates of depression among different self-assessment questionnaires in patients with SSc. • We found correlation of depression estimates in SSc-patients between the CES-D and PHQ9 scores. • Among the studies reviewed strong predictors of depression in SSc-patients were identified. These were significant GI and arthritic manifestations, increased pain and disease severity, and a lower educational level. • Importance in engaging mental healthcare professionals in the care of SSc- patients as per our study up to a third of patients may benefit from this.