P.2.h.011 Mental disorders and adverse experience in childhood in primary Sjögren's syndrome

Introduction: The physical and mental well-being of patients with primary Sjogren’s syndrome (SS) are significantly reduced [1]. Patients with SS have significantly higher scores for anxiety, depression, paranoid ideation and somatization than healthy controls. Adverse experience in childhood (AEC − mostly parental deprivation) has an important role in predisposing to mood and immuno-inflammatory rheumatic disorders in adults via chronic stress mechanisms [2]. Primary SS is a chronic, systemic autoimmune disease, characterized by lymphocytic infiltration of endocrine glands and functional impairment of the salivary and lacrimal glands; it has some pathogenic traits in common with stress-related mental disorders (MD). Objectives/Aims: To evaluate AEC and MD presentation in SS patients. Methods: Eighty inpatients (mean age 46.2±12.3 yrs) with SS were enrolled in the study. MD were diagnosed in accordance with ICD-10 criteria. Mean age of patients at first MD and SS manifestation were 31.18±14.6 and 34.6±13.3 yrs, respectively. The severity of depression, anxiety and stress was measured with HADS, MADRS, HAM-A and PSS-10. Results: Stress factors and reactions were diagnoses preceding the SS symptoms in all cases. In most cases ‘loss’, ‘frustration’, ‘disaster’ were related to acute (p< 0.02), and ‘danger’ to chronic reactions. AEC were present in 78.7% of SS patients (recurrent events − 32.5%). Chronic stress factors preceded MD in most cases (55; 68.7%). MD were diagnosed in 78 SS patients (97.5%): depressive episode (mild/moderate; single/recurrent, n = 27; 33.7%); dysthymia (n = 12; 15%); generalized anxiety disorder (n = 9; 11.3%); adjustment disorder (n = 11; 13.7%); schizotypal disorder (SD) (n = 19; 23.75%). Patients with AEC had an increased risk of developing dysthymia (OR= 1.34; 95%CI = 0.26–6.83) and depressive episode (OR= 1.75; 0.35–8.65) in adults. Recurrent depression was not found in patients with AEC. Patients with AEC had no significant differences in the MADRS, HAM-A, HADS, PSS-10 compared to patients without AEC. Nearly one-third of SS patients had visited psychiatrists in the past. Suicide attempts and suicidal thoughts had occurred in 9 (11.2%) and 9 (11.2%) patients before and during the disease, respectively. Patients with AEC had an increased risk of suicide attempts (OR= 2.15; 0.25–37.2) and suicidal thoughts (OR= 4.58; 0.25–18.5). No significant correlation was found between the severity of SS symptoms (dry eyes/mouth, lymphoma) and AEC. Patients with AEC had earlier onset of SS (33.6±13.0 vs 38.1±14.2) and MD (28.4±12.6 vs 34.1±13.5) than patients without AEC. Acute stress factors and reactions preceded the SS symptoms in all cases. Patients with AEC had higher OR for loss and other stress factors. Conclusion: AEC is a significant risk factor for depression and suicidal thoughts and attempts in patients suffering SS. MD are more pronounced in the presence of AEC. Patients with AEC are more sensitive to loss in the future repeated. Among patients suffering SS, mood disorders prevailed.