Seerat Chawla

University of Toronto
Project Title: Trajectories of Depressive Symptoms in Systemic Lupus Erythematous Over Time
Mentor: Zahi Touma, MD, Ph.D Assistant Professor of Medicine with the University of Toronto, Clinician-Scientist, Staff Rheumatologist with the University Health Network/Mount Sinai Hospital, adjunct scientist with the Institute for Work and Health, and LFA MSAC member.

Project Summary: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that affects multiple organ systems, including the central nervous system. The American College of Rheumatology has identified 19 neuropsychiatric syndromes that appear as manifestations of the autoimmune disease, often preceding the diagnosis of SLE. Among these, depression is one of the most frequently observed manifestations. With its prevalence two times higher in SLE than in the general population, depression significantly increases morbidity and mortality, as the quality of life for patients is adversely impacted by their increased suicidal ideation and poor adherence to treatment among other symptoms.

While several cross-sectional studies have been conducted on the diagnosis and treatment of depressive symptoms in SLE, the trajectory of depression has yet to be analyzed. Optimal management of the depressive symptoms is currently limited by the incomplete understanding of the course of depression and baseline factors influencing its trajectory. Even though SLE patients are at a high risk for depression, active disease only directly accounts for less than 40% of depressive events. Furthermore, due to the fluctuating periods of SLE disease exacerbation and remission, there are potential shifts in depressive symptoms over time, which are unaccounted for in depression treatment and management.

This study is a novel trajectory analysis of depressive symptoms in the 775 patients with SLE from the University of California San Francisco (UCSF) Lupus Outcomes Study (LOS) over the course of 7 years. By mapping these trajectories, we aim to identify baseline factors that influence which trajectory an SLE patient will follow. Additionally, we will investigate the factors linked to persistent or decreasing depressive symptoms. Since symptoms and severity can range, our findings will aid in determining accurate prognoses of depression in SLE patients, improving management and treatment.