Anxiety and depression among patients with axial spondyloarthritis

Abstract

Objective: The axial spondyloarthritis (axSpA) mainly affects young population and often leads to reduced mobility, but less is known about the impact it has on mental health. The objective of this study was to determine the prevalence of symptoms of anxiety and depression among axSpA patients and explore the underlying associated factors. Methods: A cross sectional survey-based study was conducted from a single center. A convenient sampling was done to include 100 patients. We included questions about disease activity, sleep, fatigue, quality of life (QoL), and work productivity. All patients were asked to fill the patient health questionnaire-9 (PHQ) for depression and general anxiety disorder-7 (GAD) for anxiety. A multivariate binomial logistic regression analysis was performed to determine associations between PHQ-9 and GAD-7 scores with various socio-demographic factors, disease activity scores, and other variables. Results : Clinically significant symptoms of anxiety and depression were present in 38% and 36% patients, respectively. Both were significantly associated with younger age at disease onset ( P < .05), high disease activity, sleep disturbances, fatigue, poor QoL, and high impact on work productivity. Misbeliefs that “doctors hide side-effects of medicines” and “all modern medicine used in treatment of axSpA causes side-effects” were also related to higher anxiety and depression scores. Depression was also found to be associated with female patients. Conclusion: Anxiety and depression are common in axSpA. They are associated with high disease activity and reduced work productivity. Patients should be regularly screened for these symptoms.

Association of anxiety, depression and resilience with overall health and functioning in axial spondyloarthritis (axSpA): a cross-sectional study

“…Previous studies have reported that patients with axSpA had higher levels of depression and anxiety as compared with the general population 53. In our study, 27.4% had possible anxiety (HADS-A≥8), which was lower than previous studies (32%–63%),52 54 55 while 21.2% had possible depression (HADS-D≥8), which was consistent with previous reports (14%–56%) 9 54. Though often comorbid, anxiety often develops prior to depression, and symptoms could have been more reflective of depression at the point of data collection, hence causing the lower prevalence of anxiety 56 57.…”

The influence of alexithymia on disease activity and quality of life in patients with axial spondyloarthritis: A cross‐sectional study

“…Inadequate regulation of emotions, known as alexithymia, may predispose individuals to psychological and somatic symptoms 13 . As mentioned above, psychological disorders, such as depression and anxiety, are closely association with alexithymia, 19,22,44 and they are also frequently observed in axSpA patients 10,11 . They can also influence the disease activity and QoL 41 .…”

“…Additionally, coexisting chronic widespread pain or chronic regional pain that is often linked to impaired quality of life and physical function is not uncommon in axSpA patients 7 . Psychological comorbidities are reported as being closely connected with potentially higher disease activity and poor outcomes in axSpA patients 10–12 …”

“…In addition, old age, low education level, male gender, and low socioeconomic conditions are reported as being associated with an increase in alexithymia 15 . Importantly, alexithymia and other psychological problems, such as depression, anxiety, and impulsivity, are remarkably widespread in axSpA patients and may negatively influence their quality of life and lower compliance with treatment 11,16–18 . Coexisting pain, alexithymia, depression, and inflammation were investigated in patients with chronic pain conditions, including temporomandibular joint disorders, chronic migraine, complex regional pain syndrome, and low back pain, as well as rheumatic diseases 19,20 …”

“…7 Psychological comorbidities are reported as being closely connected with potentially higher disease activity and poor outcomes in axSpA patients. [10][11][12] Alexithymia, a structural personality trait, is defined as a relative limitation in emotional world functioning, insufficiency in cognitive processing, insufficiency in understanding one's feelings, insufficiency in describing what one is feeling, and extroverted way of thinking or "absence of words for emotions". 13,14 The prevalence of alexithymia in the general population is around 13%, reported to 17% of these cases being in men and 10% being in women.…”