Relation Among Anxiety, Depression, Sleep Quality and Health-Related Quality of Life Among Patients with Systemic Lupus Erythematosus: Path Analysis

Hui-Juan Chen,1,2,* Hong Wang,1,2,* Li-Juan Qiu,1,2 Hua-Yun Ling,1,2 Ling-Ling Wu,1,2 Ting-Rui Wang,1,2 Ying Zhou,1,2 Yu Xue,1,2 Dong-Qing Ye,1,2 Bin Wang1,2 1Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People’s Republic of China; 2The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Bin Wang, Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, People’s Republic of China, Email wangbin@ahmu.edu.cnPurpose: This study aimed to examine the relationship between anxiety, depression, sleep quality and health-related quality of life among systemic lupus erythematosus (SLE) patients in China.Patients and Methods: After ethical approval and obtaining participants’ informed consent, a cross-sectional study was conducted in The First Affiliated Hospital of Anhui Medical University between October 1, 2021 and January 30, 2022. The data comprised demographic information, number of SLE symptoms, Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI) and Systemic Lupus Erythematosus-Specific Quality of Life Questionnaire (SLEQoL). We performed descriptive statistics, Spearman or Pearson correlations, and multiple linear regression. And Path analysis was performed to examine direct and indirect associations between these variables and health-related quality of life.Results: A total of 580 patients were recruited and 513 met our target criteria. Our final model fitted the data well: goodness-of-fit index (GFI) =0.996; adjusted goodness-of-fit index (AGFI) =0.974; comparative fit index (CFI) =0.998; root mean square error of approximation (RMSEA) =0.043. This model explained 57.3% of the variance on health-related quality of life (HRQoL) in patients with SLE and all the hypothesized paths reached significance (P< 0.05). Anxiety, depression, sleep quality, income/family, and number of SLE symptoms were related to health-related quality of life, and anxiety had the most influence on HRQoL (β=0.561).Conclusion: The study model helps to explain the relation among anxiety, depression, sleep quality and health-related quality of life in patients with SLE. It also suggests that health care professionals should be aware of factors such as anxiety, sleep quality, number of SLE symptoms, and depression in their care for HRQoL of SLE patients.Keywords: anxiety, sleep, depression, quality of life, systemic lupus erythematosus