Depression in systemic lupus erythematosus: The key role of illness intrusiveness and concealment of symptoms

Extant literature on depression in chronic illness points to the association between depression and increased morbidity (Moussavi et al., 2007). There is to date little research on the surmised reciprocal relationship between the two. This longitudinal study of 30 women suffering from systemic lupus erythematosus (SLE) was conducted using self-report measures as well as physical illness markers, in order to place depression among SLE patients within what is known of the psychosocial context of depression. The objective of this study was to differentiate between the broadly illness-related and personality-related aspects of SLE depression. Results show that depression is preceded by concealment of SLE symptoms and by illness intrusiveness, a concept reflecting the subjective illness experience. Furthermore, depression is shown to precede changes in illness intrusiveness. Thus, illness intrusiveness and symptom concealment - but not physical illness markers - emerge as key factors in understanding the co-morbidity of SLE and depression. These findings, viewed within the methodological limitations of this study, indicate the centrality of perceptions, of the 'lived experience' of the illness, in the detection and treatment of depression among women with SLE.