Elsevier

General Hospital Psychiatry

Volume 29, Issue 1, January–February 2007, Pages 21-24
General Hospital Psychiatry

Psychiatric–Medical Comorbidity
Quality of life in patients with Behçet's disease: the impact of major depression

https://doi.org/10.1016/j.genhosppsych.2006.10.001Get rights and content

Abstract

Objective

Behçet's disease (BD) is a multisystemic inflammatory disorder associated with high levels of depressive symptoms and lower quality of life (QoL). In this study, we aimed to investigate the impact of major depression (MD) on the QoL of patients with BD.

Method

BD outpatients (n=25) and psychiatric outpatients (n=25) with only MD among the Axis I psychiatric disorders, and BD outpatients (n=25) and healthy controls (n=25) without any Axis I psychiatric disorder were included in the study. The Structured Clinical Interview for DSM-IV (SCID-I) was used to determine Axis I psychiatric disorders. Depression and QoL levels were assessed with the Beck Depression Inventory (BDI) and the World Health Organization QoL Assessment–Brief (WHOQOL-BREF), respectively.

Results

There was no significant difference with regard to demographic characteristics between the groups. Psychiatric and BD patients with MD had significantly lower overall WHOQOL-BREF subscale scores than BD patients without MD and healthy controls. No significant difference was found in terms of QoL between the groups of psychiatric and BD patients with MD, nor between the groups of BD patients without MD and healthy controls. Overall, there was a significantly negative correlation between all WHOQOL-BREF subscale and BDI scores in BD patients.

Conclusion

The study suggests that concurrent MD has a negative impact on QoL of BD patients and that QoL is negatively correlated with the severity of depressive symptoms.

Introduction

Behçet's disease (BD) is a multisystemic disorder which may affect important organ systems (e.g., vascular, central nervous and gastrointestinal) in addition to the clinical triad including recurrent oral and genital ulcers, and uveitis [1], [2], [3]. It occurs most commonly in young adults and the Turkish population with prevalence rate of 42 per 10 000 [3], [4]. The etiology of BD is unknown, although genetic susceptibility, autoimmunity and environmental factors are suspected [2]. Its main pathologic lesions are vasculitis or perivascular inflammation [3].

In recent years, there has been growing interest regarding the psychiatric aspects of BD. Several studies demonstrate that there is a stress factor in most patients with BD before the initial onset or relapse of the disease [5], [6], [7]. Moreover, it has been reported that subjects with BD have higher anxiety and depression levels [5], [6] and lower quality of life (QoL) [8], [9] than healthy controls. Comorbid depression is frequent in patients with various chronic medical diseases [10], [11], [12], [13], and it strongly influences QoL in these patients [10], [14], [15], [16], [17]. Similarly, approximately 1/5 of BD patients have major depression (MD) at the time of clinical evaluation [18] and existence of clinical depression might affect QoL in patients with BD.

However, to date, the associations of MD and QoL in BD patients have not been adequately researched. Additionally, there is no study comparing the QoL of BD patients without psychiatric disorders to healthy controls. Therefore, in this study, we aimed to investigate the impact of MD, which is a relatively frequent psychiatric morbidity, on QoL in BD patients.

Section snippets

Method

The study included 214 consecutive BD outpatients who presented to the Dermatology Department of the Konya Research and Training Hospital of Başkent University between June 2005 and April 2006. Patients with central nervous system involvement due to BD (n=9) or other medical illnesses (n=1), uncontrolled endocrine abnormalities (n=4), chronic medical illnesses (n=6), and those who received systemic corticosteroid (n=17), immunosuppressive (n=5), psychotrophic (n=8) or combination (n=4)

Results

As presented in Table 1, there was no significant difference with regard to demographic characteristics among the four study groups. Overall, the mean±S.D. duration of illness was 8.58±6.78 years in BD patients (7.12±4.60 and 10.04±8.25 years in BD patients with and without MD, respectively, t=1.54, P=.131). The frequency of clinical manifestations of BD was similar in BD patients with and without MD (Table 2).

The mean±S.D. score of BDI was 25.44±5.10 in psychiatric patients with MD,

Discussion

To the best our knowledge, this is the first study to examine the impact of MD on QoL in BD patients. The results of this study demonstrate that clinical depression is an important factor that negatively affects QoL in BD patients. Our results are consistent with previous studies that reported that depressive symptoms are associated with a decrease in QoL of patients with chronic medical conditions such as multiple sclerosis [15], [16], [26], rheumatoid arthritis [27], type II diabetes [14],

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