Objectives: 1. To determine the prevalence of depression and anxiety in patients with systemic sclerosis (SSc) compared to healthy adults. 2. To estimate the impact of disease severity and socioeconomic factors on development of depression and anxiety in patients with SSc
Methods: Thirty five patients with SSc (27 women and 8 men, mean age 54 years, mean disease duration 7.5 years) and 30 healthy subjects, age- and sex-matched with SSc patients, were included in this study. Symptoms of depression and anxiety were evaluated using the Serbian versions of Beck’s Depression Inventory and Zung’s Anxiety Self-Assessment Scale. We estimated the impact of gender, age, economic status, marital status, disease duration, disease subset (limited or diffuse) and some clinical features (restrictive lung disease, pulmonary hypertension, finger-tip ulcers or gangrene, heart involvement and pain) on development of depression and anxiety in patients with SSc. Chi-square test, Fischer’s and Spearman’s tests were used for statistical analyses.
Results: Symptoms of depression were found in 68.6% of patients with SSc and 23.3% of healthy controls (p<0.01). Symptoms of depression were noticed more frequently in SSc patients with longer disease duration (<7 yrs / ≥7 yrs : 58.3% / 90.9% , p<0.05), in females (women / men : 77.8% / 37.5%, p=0.03), and in older subjects (30-39 yrs / 40-49 yrs / 50-59 yrs / >60 god : 25.0% / 42.9% / 90.9% / 76.9% , p<0.05). Symptoms of depression were found more frequently in unemployed (81.8%) and retired patients (65%), than in employed patients (25%). No difference in prevalence of depression was found in married and single patients. Symptoms of depression were found more frequently in patients with severe pain (0-3 / 4-7 / 8-10 : 27.3% / 77.8% / 93.3%, p<0.01). We did not notice a significant difference in prevalence of depression in patients with diffuse and limited SSc (lSSc / dSSc : 66.6% / 69.6%, p>0.05), in patients with or without restrictive lung disease (81.8% vs. 62.5%, p=0.17), pulmonary hypertension (72.7% vs. 66.7%, p=0.29), finger-tip ulcers or gangrene (77.8% vs. 65.4%, p=0.26), and heart involvement (66.6% vs. 68.9%, p<0.36). Symptoms of anxiety were found in 80% of patients with SSc, and 13.3% of healthy controls (p<0.01). Prevalence of anxiety was similar in patients with different gender, age, socioeconomic status, disease duration and severity. We have found a significant correlation between indices of depression and anxiety in our patients (=0.72, p<0.001)

Conclusion: Symptoms of depression and anxiety were found more frequently in patients with SSc than in healthy adults. Symptoms of depression are more common in female, unemployed and older patients, as well as in patients with severe pain and longer disease duration. Likely, disease severity has no impact on development of depression. Symptoms of anxiety were found in almost all patients, but without dependency on disease severity or socioeconomic factors. Depression and anxiety are commonly associated in patients with SSc.