{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T23:04:16Z","timestamp":1793228656239,"version":"4.5.0"},"reference-count":56,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2022,8,11]],"date-time":"2022-08-11T00:00:00Z","timestamp":1660176000000},"content-version":"unspecified","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"crossref","award":["U01DP005119"],"award-info":[{"award-number":["U01DP005119"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"crossref","award":["U01DP006488"],"award-info":[{"award-number":["U01DP006488"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Lupus Sci Med"],"accepted":{"date-parts":[[2022,7,25]]},"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Depression is common in individuals with chronic cutaneous lupus erythematosus (CCLE). However, how CCLE may impact patients\u2019 psychological well-being is poorly understood, particularly among disproportionally affected populations. We examined the relationships between depression and psychosocial factors in a cohort of predominantly Black patients with primary CCLE (CCLE without systemic manifestations).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Cross-sectional assessment of individuals with dermatologist-validated diagnosis of primary CCLE. NIH-PROMIS short-forms were used to measure depression, disease-related stigma, social isolation and emotional support. Linear regression analyses (\u0251=0.05) were used to test an a priori conceptual model of the relationship between stigma and depression and the effect of social isolation and emotional support on that association.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 121 participants (87.6%\u2009women; 85.1% Black), 37 (30.6%) reported moderate to severe depression. Distributions of examined variables divided equally among those which did (eg, work status, stigma (more), social isolation (more), emotional support (less)) and did not (eg, age, sex, race, marital status) significantly differ by depression. Stigma was significantly associated with depression (b=0.77; 95% CI0.65 to 0.90), whereas social isolation was associated with both stigma (b=0.85; 95% CI 0.72 to 0.97) and depression (b=0.70; 95% CI0.58 to 0.92). After controlling for confounders, stigma remained associated with depression (b=0.44; 95% CI0.23 to 0.66) but lost significance (b=0.12; 95% CI \u22120.14 to 0.39) when social isolation (b=0.40; 95% CI 0.19 to 0.62) was added to the model. Social isolation explained 72% of the total effect of stigma on depression. Emotional support was inversely associated with depression in the univariate analysis; however, no buffer effect was found when it was added to the multivariate model.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our findings emphasise the psychosocial challenges faced by individuals living with primary CCLE. The path analysis suggests that stigmatisation and social isolation might lead to depressive symptoms. Early clinical identification of social isolation and public education demystifying CCLE could help reduce depression in patients with CCLE.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/lupus-2022-000697","type":"journal-article","created":{"date-parts":[[2022,8,11]],"date-time":"2022-08-11T11:55:22Z","timestamp":1660218922000},"page":"e000697","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Depression, stigma and social isolation: the psychosocial trifecta of primary chronic cutaneous lupus erythematosus, a cross-sectional and path analysis"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6832-7291","authenticated-orcid":false,"given":"Cristina","family":"Drenkard","sequence":"first","affiliation":[{"name":"Department of Medicine\/Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA"},{"name":"Department of Epidemiology, Emory University School of Public Health, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina A","family":"Theis","sequence":"additional","affiliation":[{"name":"Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy T","family":"Daugherty","sequence":"additional","affiliation":[{"name":"Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles G","family":"Helmick","sequence":"additional","affiliation":[{"name":"Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charmayne","family":"Dunlop-Thomas","sequence":"additional","affiliation":[{"name":"Department of Medicine\/Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaobin","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Medicine\/Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Aspey","sequence":"additional","affiliation":[{"name":"Department Medicine\/Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ten\u00e9 T","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Emory University School of Public Health, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2361-0787","authenticated-orcid":false,"given":"S Sam","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Medicine\/Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,8,11]]},"reference":[{"key":"2025091513403711000_9.1.e000697.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2013.07.008"},{"key":"2025091513403711000_9.1.e000697.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2005.01.003"},{"key":"2025091513403711000_9.1.e000697.3","doi-asserted-by":"publisher","DOI":"10.1177\/0961203310370048"},{"key":"2025091513403711000_9.1.e000697.4","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1111\/bjd.12653","article-title":"The impact of skin damage due to cutaneous lupus on quality of life","volume":"170","author":"Verma","year":"2014","journal-title":"Br J Dermatol"},{"key":"2025091513403711000_9.1.e000697.5","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1002\/acr.23578","article-title":"Racial disparities in the incidence of primary chronic cutaneous lupus erythematosus in the southeastern us: the Georgia lupus registry","volume":"71","author":"Drenkard","year":"2019","journal-title":"Arthritis Care Res"},{"key":"2025091513403711000_9.1.e000697.6","unstructured":"HP . 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