Incidence, risk factors, and correlation with organ involvement of psychological disorders in patients with Sjögren’s syndrome

doi:10.5498/wjp.120249

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Jul 19, 2026; 16(7): 120249
Published online Jul 19, 2026. doi: 10.5498/wjp.120249

Incidence, risk factors, and correlation with organ involvement of psychological disorders in patients with Sjögren’s syndrome

Guang-Qiao He, Ci-Yuan Yu, Bi-Yuan Xu, Li-Yang Dai, Yao-Jing Li, Chong-Yang Liu, Jian-Ping Diao

Guang-Qiao He, Ci-Yuan Yu, Bi-Yuan Xu, Chong-Yang Liu, Jian-Ping Diao, Department of Rheumatology and Immunology, The Third Affiliated Hospital of Chongqing Medical University (Fangda Hospital), Chongqing 401120, China

Li-Yang Dai, Department of Information Statistics Center, The Third Affiliated Hospital of Chongqing Medical University (Fangda Hospital), Chongqing 401120, China

Yao-Jing Li, Department of Clinical Psychology, The Third Affiliated Hospital of Chongqing Medical University (Fangda Hospital), Chongqing 401120, China

Co-first authors: Guang-Qiao He and Ci-Yuan Yu.

Co-corresponding authors: Chong-Yang Liu and Jian-Ping Diao.

Author contributions: He GQ and Yu CY contributed equally as co-first authors and were responsible for data collection, statistical analysis, and manuscript drafting; Liu CY, as the principal investigator and co-corresponding author, conceived and designed the study, coordinated patient enrollment and clinical data acquisition, and supervised the interpretation of clinical findings; Xu BY assisted with data acquisition and clinical data verification; Dai LY oversaw the statistical methodology and formal data analysis; Li YJ administered and scored the psychological assessment scales and provided clinical input on the psychological evaluation framework; Diao JP supervised the overall project and critically revised the manuscript. All authors approved the final version and agreed to be accountable for all aspects of the work. Diao JP led study design, patient recruitment, data collection, clinical evaluation, and manuscript drafting. Liu CY provided overall research guidance, supervised data interpretation, critically revised the manuscript for intellectual content, and ensured clinical and methodological rigor. Both authors made substantial, equal, and indispensable contributions. Designating them as joint corresponding authors reflects their shared responsibility and ensures efficient, comprehensive communication with the journal.

AI contribution statement: No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions.

Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The Third Affiliated Hospital of Chongqing Medical University (Fangda Hospital), Chongqing, China (Approval No. 2025CDYCEC-56). The study was conducted in accordance with the Declaration of Helsinki and all applicable institutional and national ethical standards governing retrospective clinical research.

Informed consent statement: The requirement for individual written informed consent was waived by the Ethics Committee of The Third Affiliated Hospital of Chongqing Medical University (Fangda Hospital) (Approval No. 2025CDYCEC-56). The waiver was granted on the basis that the study was a retrospective observational analysis utilizing existing, fully anonymized and de-identified medical records, that no direct patient contact or additional clinical interventions were performed, and that the study posed no more than minimal risk to participants and did not affect their clinical management in any way. All data handling and processing were performed in compliance with applicable privacy and data protection regulations.

Conflict-of-interest statement: All authors declare that they have no conflicts of interest to disclose with respect to the research, authorship, or publication of this article. No funding was received from commercial or for-profit entities that could have influenced the design, conduct, analysis, interpretation, or reporting of this study.

Data sharing statement: The datasets generated and analyzed during the current study are not publicly available, as they contain information derived from patient medical records subject to institutional data governance policies. Deidentified data are available from the corresponding authors, Chong-Yang Liu and Jian-Ping Diao, at 651242@hospital.cqmu.edu.cn, upon reasonable request and subject to approval by the Ethics Committee of The Third Affiliated Hospital of Chongqing Medical University (Fangda Hospital) and compliance with applicable data protection regulations.

Corresponding author: Jian-Ping Diao, MD, Department of Rheumatology and Immunology, The Third Affiliated Hospital of Chongqing Medical University (Fangda Hospital), No. 1 Shuanghu Branch Road, Huixing Street, Chongqing 401120, China. 651242@hospital.cqmu.edu.cn

Received: March 17, 2026
Revised: May 12, 2026
Accepted: May 27, 2026
Published online: July 19, 2026
Processing time: 99 Days and 16.2 Hours

Abstract

BACKGROUND

Sjögren’s syndrome (SS) is a common systemic autoimmune disease that predominantly affects women, and typically manifests with lymphocytic infiltration of exocrine glands with wide-ranging extra glandular organ involvement. Depression and anxiety, two of the most common psychological disorders (PD) reported in patients with SS, remain undervalued on clinical practice. There are however limited, and conflicting data on the specific risk factors for PDs in SS which might be linked to severity of organ involvement, with respect to type distribution.

AIM

To evaluate the occurrence and risk factors of PDs in patients with SS and investigate their association with organ involvement.

METHODS

This retrospective study comprised a total of 286 patients with SS who met the diagnostic criteria for SS at the Department of Rheumatology and Immunology of our hospital between January 1, 2019 and December 1, 2024. Psychological status was assessed using the Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA), and patients were divided into the PD group (156 cases) and non-PD group (130 cases). Risk factors were analyzed with the help of logistic regression, while Pearson correlation analysis was applied to assess association with organ involvement.

RESULTS

Out of 286 SS patients, PDs were found in 156 patients (54.5%), including pure depression in 58 cases (20.3%), pure anxiety in 38 cases (13.3%) and depression-anxiety comorbidity, 60 cases (21.0%). PD group had higher HAMD scores (14.7 ± 6.2) and HAMA scores (12.3 ± 5.8) than without PD group respectively (all P < 0.001). Patients with PDs had more severe clinical manifestations, higher dry mouth visual analogue scale (VAS) scores (7.2 ± 1.8 vs 5.4 ± 2.1), dry eye VAS scores (6.9 ± 2.0 vs 5.1 ± 2.3) and joint pain incidence (78.27% vs 61.54%), inflammatory markers including erythrocyte sedimentation rate (42.3 ± 18.7 mm/hour vs 35.6 ± 16.17 mm/hour), C-reactive protein (8.93 ± 12.37 mg/L vs 5.68 ± 8.25 mg/L), anti-SSA/Ro52 antibody positivity rate (82.1% vs 69.2%), complement component 3 levels (85 ± 23 mg/L vs 94 ± 21 mg/L), more severe organ involvement with higher EULAR SS Disease Activity Index (ESSDAI) scores (12.4 ± 8.6 vs 7.8 ± 5.9), and significantly increased incidence of interstitial lung disease (18.5% vs 13.8%), peripheral neuropathy (16.8% vs 7.8%), and arthritis (56.4% vs 38.5%) (all P < 0.05). Multivariate analysis showed that female gender [odds ratio (OR) = 2.34], disease duration ≥ 5 years (OR = 1.89), ESSDAI ≥ 12 points (OR = 2.67), interstitial lung disease (OR = 2.15), and peripheral neuropathy (OR = 3.42) were independent risk factors. The severity of PDs was positively correlated with number of organs involved (r = 0.425), disease activity (r = 0.378), and disease duration (r = 0.589), and negatively correlated with quality of life (r = -0.656, all P < 0.001).

CONCLUSION

PDs are common in SS, predominantly as anxiety and depression. Female sex, long disease duration, high disease activity and involvement of particular organs remain key risk factors for PDs. The severity of organ involvement strongly correlates with the degrees of PDs, indicating that might be beneficial for psychologic health screening and total count administration in SS patients leading to better prognosis and quality of life.

Keywords: Sjögren’s syndrome; Mental disorders; Depression; Anxiety; Organ manifestations

Core Tip: Psychological disorders are Sjögren’s syndrome (SS), patient subjective stress inventory more than half of the studied population. Higher disease activity, longer disease duration and multi-organ involvement (especially interstitial lung disease and peripheral neuropathy) are closely tied with depression and anxiety. Quality of life correlates negatively, whereas psychological severity correlates positively with inflammatory markers. Independent risk factors included female sex and EULAR SS Disease Activity Index ≥ 12. These results demonstrate the two-way interaction between immune-mediated inflammation and mental health, indicating that regular psychological assessment alongside integrated multidisciplinary management of SS patients is warranted.