SYSTEMATIC REVIEW article
Front. Med.
Sec. Rheumatology
Risk Factors for Depression in Systemic Lupus Erythematosus: A Systematic Review and Meta-analysis
LINLING ZHU 1,2
Jinju Chen 2
Yaping Sha 2
Huiren Zhuang 3
Chunhua Ye 2
1. Tongji University, Shanghai, China
2. Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
3. The East Hospital Affiliated to Tongji University, Shanghai, China
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Abstract
Abstract: Background: Depression is highly prevalent among patients with systemic lupus erythematosus (SLE) and is associated with adverse clinical outcomes. However, evidence on its risk factors remains inconsistent, limiting early identification and targeted intervention. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA and MOOSE guidelines. Eight databases were searched from inception to May 2024 for observational studies reporting risk factors for depression in adult SLE patients assessed by validated scales. Study quality was evaluated using the Newcastle– Ottawa Scale or AHRQ criteria. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Results: A total of 26 studies (n = 8,960 patients) were included. Significant risk factors for depression included economic hardship (OR = 6.05, 95% CI: 3.64–10.07), high-dose glucocorticoid use (OR = 7.72, 95% CI: 4.62–12.90), higher disease activity (OR = 3.15, 95% CI: 2.95–3.37), unemployment (OR = 3.06, 95% CI: 1.48–6.32), lower academic qualifications (OR = 2.21, 95% CI: 1.45–3.36), presence of comorbidities (OR = 2.20, 95% CI: 1.45–3.34), smoking (OR = 3.17, 95% CI: 1.44–6.99), and greater fatigue severity (per unit increase: OR = 1.23, 95% CI: 1.08–1.40). Younger age was also associated with higher depression risk (OR = 1.97, 95% CI: 1.41–2.76). Subgroup and meta-regression analyses revealed substantial heterogeneity across studies, partially explained by geographic region and depression assessment tools. Publication bias was detected but did not alter core findings in sensitivity analyses. Conclusion: This meta-analysis identifies key clinical, demographic, and psychosocial risk factors for depression in SLE. Findings support integrating routine depression screening with holistic assessments of disease burden and social context in clinical practice, particularly within nursing-led care models.
Summary
Keywords
Depression, glucococorticoids, Meta-analysis, Risk factors, Socioeconomic Factors, systemic lupus erythematosus
Received
22 November 2025
Accepted
26 January 2026
Copyright
© 2026 ZHU, Chen, Sha, Zhuang and Ye. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Huiren Zhuang
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