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
ARTICLE HIGHLIGHTS
Research background

The prevalence of depressive and anxiety-related symptoms in newly referred patients at neurology outpatient clinics is high, and mental state of myasthenia gravis (MG) patients were seldom assessed by mental scales routinely, so little is known about the exact relationship between MG and mental disorders that often accompany it.

Research motivation

Due to the frequent occurrence of comorbidities in older people that might be confused with MG symptoms, awareness of mental disorders in older age groups of MG is needed for earlier intervention and thus a better outcome. In the present, there have been few studies on the mental health of patients with late-onset MG, so we conducted this study to assess the related factors for developing mental disorders in the subgroup of MG patients.

Research objectives

This study aimed to investigate the relationship between clinical features and mental health in patients with late-onset MG, in addition to treating physical symptoms, attention should also be paid to mental disorders in late-onset MG patients.

Research methods

A total of 105 patients diagnosed with MG were recruited consecutively from a neuromuscular outpatient clinic between December 2020 and February 2021 in our hospital. Clinical data including sociodemographic, neurological and mental information were collected, and scores on clinical scales were procured through face-to-face evaluations with professional neurologists. The relationship between clinical features and mental health in late-onset MG patients was examined using multivariate logistic regression analyses.

Research results

Late-onset MG patients had higher total scores on the MG 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) compared with early-onset group MG patients. Female patients had higher total HAM-D and HAM-A scores than male patients among late-onset MG (P < 0.05), and high scores on the MG-QOL-15 questionnaire were independently associated with higher incidences of anxiety and depression. In late-onset groups, the areas under the receiver operating characteristic curves for MG-QOL-15 scores at a cutoff value of 14.5 in the anxiety and depression groups were 0.816 and 0.983, respectively.

Research conclusions

We found that female patients with late-onset MG were more susceptible to anxiety and depression than their male counterparts, and that higher MG-QOL-15 scores were an independent risk factor for anxiety and depression in patients with late-onset MG. An MG-QOL-15 score cutoff of 14.5 could be a good indicator for poor mental health in need of attention among late-onset MG patients.

Research perspectives

In the future, we will seek to determine protective factors against developing mental disorders among late-onset MG. Further follow-up and particularly studies that include healthy control groups are needed to validate the results.