OBJECTIVES: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease that can impact multiple organ systems. Changes in appearance/body image dissatisfaction are common in SLE and can contribute to increased depression and poor quality of life. Theoretical models examining body image in SLE are lacking. The present study examined the role of key psychosocial variables as potential mediators in the relationship between body image and depression in patients with SLE.

METHODS: A convenience sample was obtained of patients aged 18 years and above diagnosed with SLE according to ACR 1982 guidelines at a large medical center in Southern California. Participants completed the Body-Image and psychosocial self-report questionnaires to assess functioning. Multiple mediation analysis was completing using an SPSS macro called “PROCESS.”

RESULTS: The cohort of 135 patients had a mean age of 48.6 years(SD = 13.87) and was mostly female (92.6%) and Caucasian (44.9%). The direct effect of body image on depressive symptoms was -0.046, p < .001. In addition, the relationship between body image and depressive symptoms was significantly decreased when helplessness, social support, and stress were included in our model, ab=-.054, BCa 95%CI[-.069, -.040]. Self-esteem, helplessness, and social support were all identified as mediators of this relationship, respectively(ab=-.017, BCa95%CI[-0.032,-.003;ab = -.025, BCa95%CI[-0.040, -.011;ab = -.010, BCa95%CI [-0.021,-.009]) as zero was not included in the CIs; however self-efficacy was not found to be a mediator (ab=-.002, BCa95%CI [-0.012,-.007]).

CONCLUSIONS: Body image concerns are commonly reported among patients with SLE. This analysis provides a theoretical understanding of the relationship between body image concerns and resulting depressive symptoms in SLE. Findings from this study suggest that it is important to understand levels of self-esteem, helplessness, and social support among SLE patients with body image concerns. Interventions that target these psychosocial mediators may improve symptoms of depression in SLE.