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John Alexander Gonzales, Jennifer Rose-Nussbaumer, Vatinee Y. Bunya, Caroline Shiboski, Tom Lietman; Depression in patients with and without Sjögren's syndrome from the Sjögren's International Collaborative Clinical Alliance. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6215.
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© ARVO (1962-2015); The Authors (2016-present)
The Sjögren’s International Collaborative Collective (SICCA) is an NIH- and NEI-funded multicenter prospective cohort study exploring the etiology, diagnosis and treatment of Sjögren’s syndrome (SS). Depression has been associated with primary SS as well as with chronic ocular diseases such as uveitis, macular degeneration, and glaucoma. In this study we evaluate whether or not an elevated ocular staining score (OSS) is associated with higher scores on depression screening.
Patients enrolled into the SICCA registry between 2004 and 2010 had assessment of American College of Rheumatology (ACR) SS criteria and depression using the Patient Health Questionnaire-9 (PHQ9) at baseline. The association between ACR criteria or ocular symptoms and depression was analyzed using the Cochrane-Armitage test for trend.
Of 3,409 patients enrolled into the SICCA cohort, 1,578 (46%) met ACR criteria for SS while 1,831 (54%) did not. There was a statistically significant difference in the number of patients who indicated "no depression" in those with SS compared to those without SS (48% vs. 33%, p < 0.001). Additionally, we found a difference in the number of patients who indicated no depression in those with OSS ≥ 3 compared to those with an OSS < 3 (42% vs. 35%, p < 0.001) and in patients with a LSGB focus score ≥ 1 compared to those with a negative LSGB focus score (48% vs. 35%, p < 0.001). Stratifying by race, the association between LSGB focus score and depression as well as OSS and depression was only statistically significant for non-Caucasians. Patients who complained of light sensitivity, gritty/scratchy sensation, and burning/stinging “half or more the time” compared to “some/none of the time“ had statistically significantly higher scores of depression (all p < 0.001). There was a higher proportion of patients who “never use artificial tears” having “no depression” compared to those using artificial tears “≥10 times a day” (47% vs. 33%, p < 0.001).
Symptoms of ocular discomfort (light sensitivity, gritty/sandy sensation, and burning/stinging) were associated with higher depression scores. Interestingly, meeting ACR criteria for a diagnosis of SS was not associated with higher depression scores in our cohort. Depression in patients with ocular discomfort ascribed to dry eye deserves recognition.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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