Anxiety-depressive spectrum disorders in patients with obstetric antiphospholipid syndrome

The aim – to determine the frequency and characteristics of anxiety-depressive spectrum disorders (ADSD) in patients with obstetric antiphospholipid syndrome (APS).

Material and methods. The study is prospective-retrospective. Data on obstetric pathology was obtained from medical documents and from conversation with a patient. Stress factors were assessed upon inclusion in the study. Diagnosis of ADSD was carried out by a psychiatrist, according to ICD-10. The study included 61 women with APS, established according to the international criteria of 2006, who had a history of pregnancy. 30 (49.2%) of 61 patients had pregnancy loss (PL). Systemic lupus erythematosus (SLE) was diagnosed in 29 (47.5%) women. The average age of patients at the time of inclusion in the study was 40.9±11.0 years: 41.2±7.77 years in patients with PL and 40.7±12.8 years in patients without PL.

Results. ADSD were identified in the majority of women with APS – 53 (86.9%) out of 61. These mental disorders developed in the majority of patients before the onset of APS (37 (69.8%) out of 53). Moderate and severe depression in patients with PL was more related to stressful events not associated with APS (mainly with childhood and adolescent psychological trauma), and was also more often detected in the presence of PL after the week 10 of gestation and more than two PL. Childlessness as a stress factor at the time of the study was significant for 7 (38,9%) out of 18 patients with PL who did not have children. Almost half (14 (46.7%) out of 30) of patients with PL had more than two interrupted pregnancies (multiple PL). In the group of patients with multiple PLs, significantly more often than in patients with one or two PLs, a pronounced distortion of logical thinking was detected, while the frequency of organic-type thinking disorders associated with ischemic damage to the central nervous system within the framework of APS did not differ in patients in the compared groups.

Conclusion. The incidence of depression in women with APS did not depend on a history of PL. Multiple PLs predisposed to more severe types of depression. The psychopathological features of ADSD in patients with multiple PLs were determined – more frequent pronounced distortions of logical thinking. It has been established that childlessness is not a significant stress factor for all patients.

1. Nasonov EL (ed.). Rheumatology. Russian clinical recommendations. Moscow: GEOTAR-Media;2017 (In Russ.).

2. Barbhaiya M, Zuily S, Naden R, Hendry A, Manneville F, Amigo MC, et al.; ACR/EULAR APS Classification Criteria Collaborators. 2023 ACR/EULAR antiphospholipid syndrome classification criteria. Ann Rheum Dis. 2023;82(10):1258-1270. doi: 10.1136/ard-2023-224609

3. Borisova АВ, Lisitsyna ТА, Veltishchev DYu, Reshetnyak ТМ, Seravina ОF, Kovalevskaya ОВ, et al. Mental disorders in antiphospholipid syndrome patients: Association with clinical and immunological manifestations of the disease. Nauchno-Prakticheskaya Revmatologia = Rheumatology Science and Practice. 2024;62(2):176-185 (In Russ.). doi: 10.47360/1995-4484-2024-176-185

4. Gris JC, Cyprien F, Bouvier S, Cochery-Nouvellon E, Lavigne-Lissalde G, Mercier E, et al. Antiphospholipid antibodies are associated with positive screening for common mental disorders in women with previous pregnancy loss. The NOHA-PSY observational study. World J Biol Psychiatry. 2019;20(1):51-63. doi: 10.1080/15622975.2017.1333146

5. Mergl R, Quaatz SM, Lemke V, Allgaier AK. Prevalence of depression and depressive symptoms in women with previous miscarriages or stillbirths – A systematic review. J Psychiatr Res. 2024;169:84-96. doi: 10.1016/j.jpsychires.2023.11.021

6. Ishtiaque S, Sultana S, Malik U, Yaqoob U, Hussain S. Prevalence of antenatal depression and associated risk factors among pregnant women attending antenatal clinics in Karachi, Pakistan. Rawal Medical Journal. 2020;45(2):434-438.

7. Kosheleva NM, Khuzmieva SI, Alekberova ZS. Systemic lupus erythematosus and pregnancy. Nauchno-Prakticheskaya Revmatologia = Rheumatology Science and Practice. 2006;(2):52-59 (In Russ.).

8. Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4(2):295-306. doi: 10.1111/j.1538-7836.2006.01753.x

9. Kakorina EP, Maksimova MV, Mishnev OD. Use of the International Classification of Diseases and related health problems, tenth revision (ICD-10) in the practice of domestic medicine. 2009 (In Russ.).

10. de Almeida Macêdo E, Appenzeller S, Lavras Costallat LT. Assessment of the Hospital Anxiety and Depression Scale (HADS) performance for the diagnosis of anxiety in patients with systemic lupus erythematosus. Rheumatol Int. 2017;37(12):1999-2004. doi: 10.1007/s00296-017-3819-x

11. Levis B, Sun Y, He C, Yin Wu, Krishnan A. Accuracy of the PHQ-2 alone and in combination with the PHQ-9 for screening to detect major depression systematic review and meta-analysis. JAMA. 2020;4(22):2290-2300. doi: 10.1001/jama.2020.6504

12. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385-396. doi: 10.2307/2136404

13. Loginova SV, Rubinstein SY On the application of the “pictogram” method for experimental research of the thinking of mentally ill patients. 1972 (In Russ.).

14. Zeigarnik BV. Disorders of thinking in mentally ill patients. 1958 (In Russ.).

15. Zeigarnik BV. Pathology of thinking. 1962. (In Russ.).

16. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-699. doi: 10.1111/j.1532-5415.2005.53221.x

17. Piaget J. Psychology of intelligence. Saint Petersburg:Piter;2004 (In Russ.).

18. Bolshunova TV. The childfree phenomenon: A macrosociological analysis. Vestnik Universiteta. 2018;(4):145-149 (In Russ.). doi: 10.26425/1816-4277-2018-4-145-149

19. Stahnke B, Cooley ME, Blackstone A. A systematic review of life satisfaction experiences among childfree adults. Family J. 2023;31(1):60-68. doi: 10.1177/10664807221104795

20. Yucel H, Demirel N, Bas AY, Isik DU, Kulali F, Mollamahmutoğlu L, et al. A sociodemographic analysis of mothers who abandoned their newborn babies: A single-center study. Turkish J Pediatr Dis. 2020:15(2):1-5. doi: 10.12956/tchd.642744

21. Papaligoura ZG, Papadatou D, Bellali T. The wish for a child among individuals who conceive with assisted reproduction technologies. J Reprod Infant Psychol. 2012;30(5):461-467. doi: 10.1080/02646838.2012.744960

22. Sugiura-Ogasawara M, Furukawa TA, Nakano Y, Hori S, Aoki K, Kitamura T. Depression as a potential causal factor in subsequent miscarriage in recurrent spontaneous aborters. Hum Reprod. 2002;17(10):2580-2584. doi: 10.1093/humrep/17.10.2580

23. Gameiro S, van den Belt-Dusebout AW, Bleiker E, Braat D, van Leeuwen FE, Verhaak CM. Do children make you happier? Sustained child-wish and mental health in women 11–17 years after fertility treatment. Hum Reprod. 2014;29(10):2238-2246. doi: 10.1093/humrep/deu178

24. Alekseeva SA. Predisposing role of childhood mental trauma in immunoinflammatory rheumatic diseases and mental disorders. Nauchno-Prakticheskaya Revmatologia = Rheumatology Science and Practice. 2022;60(4):438- 444 (In Russ.) doi: 10.47360/1995-4484-2022-438-444

25. Cheldieva FA, Reshetnyak TM, Lila AM. Assessment of the activity and organ damage in antiphospholipid syndrome. Modern Rheumatology Journal. 2021;15(4):101-106 (In Russ.). doi: 10.14412/1996-7012-2021-4-101-106

26. Shishkovskaya TI, Khudyakova MV, Baranov PA, Oleichik IV. Modern approaches to the assessment of thinking disorders in patients with endogenous psychoses. Social and Clinical Psychiatry. 2023;33(1):56-67 (In Russ.).

27. Zeigarnik BV. Pathopsychology. Moscow:Izdatelstvo moskovskogo universiteta;1986 (In Russ.).

28. Merleau-Ponty M. Phenomenology of perception. Saint Petersburg: Nauka;1999 (In Russ.).

29. Lyzlov AV, Seravina OF, Kovalevskaya OB. Affectivity as a structure-forming basis of anthropological spaces: Philosophy, psychology, psychiatry. Voprosy Psychologii. 2010;(3):65-74 (In Russ.).

30. Lyzlov AV, Kovalevskaya OB, Seravina OF. Apathy as a nuclear affect: An experience of structural-psychological analysis. Voprosy Psychologii. 2013;2:65-79 (In Russ.).

31. Bleikher VM. Disorders of Thinking. Kiev:Zdorovya;1983 (In Russ.).

32. Zurlo MC, Cattaneo Della Volta MF, Vallone F. Paths towards parenthood after repeated treatment failures: A comparative study on predictors of psychological health outcomes in infertile couples persisting in treatments or opting for adoption. Front Psychol. 2023;14:1147926. doi: 10.3389/fpsyg.2023.1147926