Associations Between Mental Health Diagnoses and Recurrent Acute Care Use Among Individuals with Systemic Lupus Erythematosus in the All of Us

Objective We investigated prospective associations between mental health conditions (depression, anxiety, and post-traumatic stress disorder, PTSD) and recurrent acute care use among patients with systemic lupus erythematosus (SLE). Methods Within All of Us Research Program (version 8), a US-wide cohort of adults enrolled and consented for linkage to electronic health records, we identified those with SLE by ICD-10 or SNOMED codes pre-enrollment. We assessed baseline depression, anxiety, and/or PTSD using ICD-10 or SNOMED codes. Outcomes included emergency department visits and hospitalizations after enrollment. Incidence rates (IR) for acute care events among patients with vs. without mental health diagnoses were calculated. Multivariable negative binomial regression models estimated incidence rate ratios (IRR, 95% confidence intervals), adjusting for sociodemographic factors and comorbidities. Results Of 2,160 patients with SLE: 973 had depression, anxiety, and/or PTSD (mean age 49.4 [13.5] years, 92.8% female); 1,187 did not (mean age 50.4 [14.9] years, 88.1% female). Those with ≥ 1 mental health condition had lower education and income, and more smoking and comorbidities. Patients were followed for mean 3.02 (1.73) years. ≥ 1 mental health diagnosis was strongly associated with higher emergency visit (adjusted IRR 1.90, 1.60-2.27) and hospitalization rates (IRR 1.33, 1.08-1.65). This was true for emergency visits and hospitalizations for SLE (IRR 1.42, 1.19-1.69) and for non-SLE (IRR 1.42, 1.17-1.74). Conclusion In this nationwide SLE cohort, those with vs. without mental health diagnoses had increased SLE and other cause acute care use. Further studies are needed to understand if effective treatment for mental health diagnoses alters care patterns.