Mental Health and Lupus: A Global Perspective
An in-depth feature from Lupus Canada’s “Let’s Talk Lupus: A Pathway to Progress” campaign.
Why Mental Health Matters in Lupus Care
Within the last decade, several studies have highlighted the importance of mental health care and how a lack of treatment can negatively impact one’s physical health and overall well-being.
In Canada alone, one in five people live with a mental illness, and 13.3% of people have a general anxiety disorder, according to the Canadian Mental Health Association.
Poor mental health can affect anyone’s quality of life, but anxiety and depression are especially common among people living with lupus. That’s why days like World Mental Health Day are so important to the lupus community—as it highlights the need for mental health education, awareness, and advocacy.
Insights from the Let’s Talk Lupus Project
Lupus Canada conducted interviews for the ‘Let’s Talk Lupus: A Pathway to Progress’ project, a three-phase campaign that highlights international perspectives on lupus care.
Lupus Canada facilitated conversations to dive deeper about mental health care for lupus patients.
“Mental health is a crucial aspect of treatment that should be integrated into medical care,” said Dr. Andrea Knight, Clinician-Investigator in the Division of Rheumatology and Associate Scientist in the Neurosciences and Mental Health at The Hospital for Sick Children.
“It is important to be proactive, especially because mental health issues can be part of lupus, and it’s a standard of care we should have.”
What Research Shows About Mental Health and Lupus
A 2023 research paper conducted by Reumatologia found that depression, anxiety, and stress are common in patients with lupus, and the quality of a patient’s life is significantly affected.
Another study by the British Society of Rheumatology found that anxiety and depression are common among those diagnosed with lupus.
“It is imperative to identify symptoms of anxiety and depression to promptly refer patients with SLE (lupus) experiencing suicidal ideation to clinical psychologists or psychological counselling,” the study stated.
Despite the bias faced by those with both lupus and mental health conditions, increased education and research are leading to better integration of mental health care in lupus treatment.
“We’ve worked really hard to have mental health screening in our rheumatology clinic. The screening has really helped our patients with lupus specifically to address mental health issues that may otherwise have been neglected.”
Expert Perspectives from Around the World
Dr. Guillermo Ruiz-Irastorza – Spain
Dr. Guillermo Ruiz-Irastorza, researcher and coordinator of the Autoimmune, Inflammatory and Infectious Diseases Area of BioCruces Health Research Institute in Spain, explained that providing mental health resources for lupus patients is vital for treatment.
“Ten years ago, we decided to offer a psychiatrist to come in one day a week for our patients,” said Dr. Ruiz-Irastorza. “Our patients know we provide the help if they need it, and that makes all the difference.”
Dr. Ruiz-Irastorza reiterates that although clinicians are not psychiatrists, they should still recognize if a patient is demonstrating symptoms of a mental health disease.
“Not only for the technical treatment, but also to understand how they feel,” he said.
Dr. Ruiz-Irastorza was a part of a Pisa study that determined that patients with rheumatic diseases preferred to speak less about their illness and more about their lives with their clinicians. This, Dr. Ruiz-Irastorza points out, was something that stuck with him throughout his career.
“If we recognize mental health and address it, the lupus will also improve.”
Dr. Jorge Sanchez-Guerrero – Canada
Due to lupus being a disease that impacts major organs, the brain is no exception. Dr. Jorge Sanchez-Guerrero, Rheumatologist at UHN’s Lupus Clinic and Toronto Western Hospital, explained that the disease can manifest and impact the brain in many ways, such as neuropsychiatric lupus (NPSLE), which can cause psychotic symptoms like hallucinations and delusions.
A 2011 study by J Clin Psychiatry found that psychiatric symptoms are present in the majority of patients with SLE. Depression (in up to 39% of patients) and cognitive dysfunction (up to 80%) are the most common psychiatric manifestations.
Integrating Mental Health into Lupus Treatment
Across the world, there’s growing recognition that mental health is inseparable from physical health, with countries introducing mental health screening within rheumatology, expanding research, and emphasizing more patient-centred approaches.
For Dr. Knight, Dr. Ruiz-Irastorza, and Dr. Sanchez-Guerrero, mental health must be included in the conversation when treating a patient with lupus, in addition to providing mental health resources.