P. Chen, E. Broadbent, C. Coomarasamy, P. Jarrett P
Psychological distress is common in patients with Discoid
Lupus Erythematosus (DLE). Patients’ perceptions of their
illness may better predict functional outcomes than
clinician-based assessments.
This study compared patients’ perception of DLE with physician
ratings of severity and to assess their relationships
with patient depression and Quality of Life (QoL).
24 patients completed psychological questionnaires; the
Brief Illness Perception Questionnaire, Patient Health Questionnaire
and dermatology life quality index and drawing
pictures of their faces. Cutaneous lupus disease area severity
index (CLASI) was measured.
Sixteen patients screened positive for depression, six of
whom had severe depression. Disease severity was significantly
associated with depression (r = 0.41, p = 0.05). There
was no association between the patients’ perception of the
extent of their skin lesions measured by spot area compared
to the disease activity and damage scores, respectively
(r = 0.32 p = 0.13, r = 0.14, p = 0.5), however there was a
trend for patients with higher severity to draw more spots
(r = 0.42, p = 0.06). Those who drew larger faces had higher
depression scores (r = 0.53, p = 0.008). Those who had
higher perceived control over their DLE had higher QoL,
lower depression and better disease control.
Patients with more severe inflammatory disease measured
by the CLASI were more likely to be depressed. Patients’
perception of their disease differs from the dermatologists
CLASI assessments and this has implications for management.
Drawings and questionnaires may be a useful way to
understand patients’ views of the disease, and a starting
point for discussion around QoL and distress.