Increased risk of depression in patients with cutaneous lupus erythematosus and systemic lupus erythematosus: a Danish nationwide cohort study  Jeanette Halskou Hesselvig1, Alexander Egeberg1, Kristian Kofoed1, Gunnar Gislason2, Lene Dreyer3,4,5 1 Department of Dermatology and Allergy, Herlev and Gentofte University Hospital, Copenhagen, Denmark 2 Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark 3 Department of Rheumatology, Herlev and Gentofte University Hospital, Copenhagen, Denmark 4 The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark 5 Departments of Clinical Medicine and Rheumatology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark British Journal of Dermatology. DOI: 10.111/bjd.16831

Lead author: Jeanette Halskou Hesselvig

Introduction What’s already known? Reported prevalences of depression in patients with systemic lupus erythematosus (SLE) range widely, while the prevalence of depression in cutaneous lupus erythematosus (CLE) remains severely understudied

Objective To examine whether patients with SLE or CLE have increased risk of depression

Methods A nationwide observational cohort study based on the Danish health registers We included patients ≥18 years with a first-time diagnosis of SLE or CLE between 2000­­­–2015 We matched the cases (SLE or CLE) with general population in a 1:10 ratio

Methods Analyses of risk for depression and antidepressant use were performed in Cox regression models The analyses were adjusted for age, sex, socio- economic status, smoking, alcohol abuse, prior depression, and prior antidepressant use

Results The study comprised 1,424 and 2,065 patients with CLE and SLE, respectively, matched with 34,890 people from the general population We followed the patients with CLE and SLE for 8,103 and 15,270 person- years, respectively

Results SLE and CLE were associated with a significantly increased risk of depression and antidepressant use (Table 2) Table 2 Crude and adjusted hazard ratios for depression and antidepressant use in patients with lupus erythematosus compared with the general population Table 2 Crude and adjusted hazard ratios for depression and antidepressant use in patients with lupus erythematosus compared with the general population

Results Patients with SLE or CLE had an increased risk of severe depression compared with general population (Fig. 1) Severe depression was defined as a hospitalization due to depression at a Department of Psychiatry or at a hospital in general Department of psychiatry Department of psychiatry

Discussion We found a 2-fold increased risk of depression in patients with CLE or SLE compared with the the general population in Denmark The risk of depression is of similar magnitude in CLE and SLE indicating that the involvement of the skin as well as the systemic involvement affects the overall risk of depression

Discussion The cause for the increased risk of depression remains unclear It can be a direct consequence of the disease as due to the systemic inflammation, or an indirect consequence as due to the psychological burden of having a chronic disease

Conclusions What does this study add? In this nationwide cohort study patients with CLE or SLE had a 2-fold increased risk of depression compared with the general population in Denmark

Research Team Jeanette Halskou Alexander Egeberg Kristian Kofoed Gunnar Gislason Lene Dreyer Hesselvig

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