ORIGINAL ARTICLE Evaluation of quality of life in relation to anxiety and depression in primary Sjo ¨gren’s syndrome Vedat Inal • Gul Kitapcioglu • Gonca Karabulut • Go ¨khan Keser • Yasemin Kabasakal Received: 11 March 2010 / Accepted: 28 May 2010 / Published online: 29 June 2010 Ó Japan College of Rheumatology 2010 Abstract The aim of this study was to evaluate health- related quality of life (HR-QOL) in patients with primary Sjo ¨gren’s syndrome (pSS) using both Short-Form 36 (SF-36) and World Health Organization Quality of Life Assessment–BREF (WHOQOL-BREF) questionnaires and to determine the effects of anxiety and depression on HR-QOL using the Hospital Anxiety–Depression Scale (HADS). In this cross-sectional study, 107 female patients with pSS (mean age 54.10 ± 10.2 years), fulfilling US– European Consensus Criteria and 109 female controls (mean age 53.4 ± 10.9 years) were included. Student’s t test, Mann–Whitney U test, and analysis of variance (ANOVA) were used for statistical analysis. P values [ 0.05 were accepted as significant. All domains of the SF-36, with the exception of ‘‘Vitality’’, and all domains of the WHOQOL-BREF with the exception of ‘‘Environment’’, were significantly lower in pSS patients compared with healthy controls. In pSS patients having anxiety according to HADS, the scores of all domains of WHOQOL-BREF were significantly lower, and in patients having depression according to HADS, three of four domains of WHOQOL- BREF were significantly lower compared with the rest of the group. However, the scores of two domains of the SF-36, namely ‘‘Role-Physical’’ and ‘‘Role-Emotional’’ domains, were significantly higher in pSS patients having depression according to HADS. We confirmed the presence of impaired HR-QOL in pSS. Whereas the presence of anxiety and/or depression generally showed a negative affect on HR-QOL, interestingly, depression seemed to improve the scores of ‘‘Role-Physical’’ and ‘‘Role-Emo- tional’’ domains of the SF-36. This surprising finding might be related to adaptation to changing health. Social support based upon cultural traditions might also have contributed. Keywords Sjo ¨gren’s syndrome Á Quality of life Á SF-36 Á WHOQOL-BREF Á HADS Introduction Sjo ¨gren’s syndrome is a slowly progressive, inflammatory, autoimmune disease affecting primarily the exocrine glands, which then leads to clinical features of dry eyes and dry mouth. Extraglandular involvement including arthritis, pulmonary disease, renal disease, and vasculitis may also occur. In isolation, Sjo ¨gren’s syndrome is termed ‘‘primary’’ and when in combination with another auto- immune disease, ‘‘secondary’’ [1, 2]. Primary Sjo ¨gren’s syndrome (pSS) can occur at all ages, but it affects pri- marily women during the fourth and fifth decades of life, with a male/female ratio of 9/1, and its prevalence esti- mates range from approximately 0.5 to 2% [2–5]. Quality of life (QOL) is defined as an individual’s per- ceptions of his/her position in life in the context of the culture and value systems in which he/she lives and in relation to his/her goals, expectations, standards, and con- cerns [6, 7]. Being a chronic systemic autoimmune disease, pSS may cause fatigue and negatively affect physical, psychological, and social functioning and may also cause disability [8–10]. Therefore, pSS has the potential to impair both the health-related quality of life (HR-QOL) and psy- chological state. For evaluating HR-QOL in patients with V. Inal Á G. Karabulut (&) Á G. Keser Á Y. Kabasakal Division of Rheumatology, Department of Internal Medicine, Ege University School of Medicine, Izmir, Turkey e-mail: gonca4us@yahoo.com G. Kitapcioglu Department of Biostatistics and Medical Informatics, Ege University School of Medicine, Izmir, Turkey 123 Mod Rheumatol (2010) 20:588–597 DOI 10.1007/s10165-010-0329-z