Observational Study
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World J Psychiatry. Mar 19, 2022; 12(3): 470-482
Published online Mar 19, 2022. doi: 10.5498/wjp.v12.i3.470
Studying the relationship between clinical features and mental health among late-onset myasthenia gravis patients
Lu Yu, Li Qiu, Hao Ran, Qian Ma, Ya-Ru Lu, Wei-Bin Liu
Lu Yu, Li Qiu, Qian Ma, Ya-Ru Lu, Wei-Bin Liu, Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
Hao Ran, School of Pharmaceutical Science, Sun Yat-sen University, Guangzhou 510006, Guangdong Province, China
Author contributions: Liu WB was the guarantor and contributed to the conception of the study; Yu L and Qiu L participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Ran H, Ma Q, Lu YR revised the article critically for important intellectual content.
Supported by the National Natural Science Foundation of China, No. 81873772 and 81971754; National Natural Science Foundation Key International (Regional) Cooperation Research Project, No. 81620108010; Clinical Study of 5010 Planned Project Sun Yat-sen University, No. 2010003; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, No. 2020B1212060017; Guangdong Provincial Clinical Research Center for Neurological Diseases, No. 2020B1111170002; the Southern China International Cooperation Base for Early Intervention and Functional Rehabilitation of Neurological Diseases, No. 2015B050501003 and 2020A0505020004.
Institutional review board statement: This study was reviewed and approved by the ethics committee of The First Affiliated Hospital of the Sun Yat-sen University.
Informed consent statement: All study participants provided informed written consent prior to the scale-based clinical examinations.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Bin Liu, MD, Chief Physician, Professor, Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China. liuwb@mail.sysu.edu.cn
Received: August 1, 2021
Peer-review started: August 1, 2021
First decision: December 4, 2021
Revised: November 26, 2021
Accepted: February 22, 2022
Article in press: February 22, 2022
Published online: March 19, 2022
Abstract
BACKGROUND

Mental disorders are common comorbidities among individuals with neurological diseases, and the prevalence of depressive and anxiety-related symptoms in newly referred patients at neurology outpatient clinics is high. There have been few studies on the mental health of patients with late-onset myasthenia gravis (MG).

AIM

To examine the relationship between clinical features and the mental health symptoms within late-onset MG patients.

METHODS

A total of 105 patients diagnosed with MG were recruited consecutively from a neuromuscular outpatient clinic between December 2020 and February 2021. Patients were classified into two groups: early-onset MG (age at onset < 50 years, n = 63) and late-onset MG (age at onset ≥ 50 years, n = 42). Social demographic data and information about marital status, education level, clinical symptoms, serum antibody levels, and therapies used were collected for all participants. Participants were also evaluated using the Myasthenia Gravis Composite scale, the Myasthenia Gravis Activities of Daily Living scale, the Myasthenia Gravis Quality of Life 15 (MG-QOL-15) questionnaire, the 17-item version of the Hamilton Depression Rating Scale (HAM-D) and the Hamilton Anxiety Rating Scale (HAM-A). The relationship between clinical features and mental health in late-onset MG patients was examined using multivariate logistic regression analyses.

RESULTS

Late-onset MG patients were more prone to dyspnea, had higher levels of serum anti-acetylcholine receptor antibodies, and higher total scores on the MG-QOL-15, HAM-D, and HAM-A questionnaires, than early-onset MG patients had (P < 0.05). Among those with late-onset MG, female patients had higher total HAM-D and HAM-A scores than male patients had (P < 0.05). High scores on the QOL-15 questionnaire were associated with higher incidences of anxiety and depression, and the association was found to be independent after adjusting for confounding risk factors. In the late-onset subgroup, the areas under the receiver operating characteristic curves for the MG-QOL-15 score-based diagnostic accuracy for anxiety and depression state were 0.816 (P = 0.001) and 0.983 (P < 0.001), respectively.

CONCLUSION

Higher MG-QOL-15 scores were a risk factor for anxiety and depression in late-onset MG, and women with late-onset MG were more likely to have anxiety and depression than men were.

Keywords: Mental health, Late-onset myasthenia gravis, Anxiety, Depression

Core tip: Mental disorders are the common comorbidities among myasthenia gravis (MG) patients in older age. In this study, we found that female patients with late-onset MG were more susceptible to anxiety and depression than their male counterparts, and that higher scores on the Myasthenia Gravis Quality of Life 15 questionnaire were an independent risk factor for anxiety and depression in patients with late-onset MG. This is the first report detailing the relationship between clinical features and mental health in the subgroup of MG patients with late disease onset.