Determinants of psychological well-being in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data

Abstract

ObjectivesThe aim of this study was to assess the psychological well-being and to analyse factors associated with depressive symptoms in axial spondyloarthritis (axSpA).MethodsA stratified random sample of subjects with a diagnosis of axSpA (International Classification of Diseases, Tenth Revision, German Modification M45) was drawn from health insurance data in Germany. These persons received a postal questionnaire on disease-related, psychological and lifestyle factors as well as socioeconomic status. Additional information to verify the axSpA diagnosis was also collected. The psychological well-being was assessed by means of the 5-item WHO Well-Being Index (WHO-5), which is considered a screening tool for depression. The following established cut-offs on the WHO-5 were applied: >50: good well-being, no depressive symptoms; 29–50: mild depressive symptoms; ≤28: moderate-to-severe depressive symptoms. Information on comorbidities, drug prescriptions and non-pharmacological treatment was retrieved from claims data and linked to the questionnaire data.ResultsA total of 1736 persons with a confirmed axSpA diagnosis were included. Using the cut-offs on the WHO-5, 533 persons (31%) were found to have moderate-to-severe depressive symptoms, 479 (28%) had mild depressive symptoms and 724 (42%) had a good well-being. Multivariable logistic regression revealed that higher disease activity, higher level of functional impairment, lower income, self-reported stress and lack of exercise, and younger age represent factors associated with moderate-to-severe depressive symptoms.ConclusionsThe prevalence of depressive symptoms in axSpA subjects is high and associated with disease-related parameters, socioeconomic status and lifestyle factors. These findings highlight the need for the careful evaluation of depressive symptoms as a part of the management strategy for axSpA.

Supervised Group Exercise in Axial Spondyloarthritis: Patients' Satisfaction and Perspective on Evidence‐Based Enhancements

“…Additional use of qualitative methods, like semistructured interviews with patients to get insight into potential barriers and facilitators, could be of value before actual implementation. Second, despite the known effects of exercise on psychosocial well‐being , questions on perceived effects of SGE only addressed physical health. It is, however, conceivable that our observation that patients (on average) participate in SGE for many years is related to perceived positive effects that go beyond physical functioning.…”

“…Regular exercise is considered to be a key component in the management of axial SpA and has been shown to reduce disease activity, pain, and stiffness and improve physical functioning, chest expansion, spinal mobility, and cardiorespiratory function in patients with axial SpA . Additionally, regular exercise has the potential to reduce depressive symptoms . With supervised group exercise (SGE), greater improvements in quality of life, spinal mobility, and patient global assessment were achieved as compared to unsupervised, individual exercise programs .…”

Reality of care for musculoskeletal diseases at the population level

“…But there is also evidence that certain diseases are underdiagnosed. These include OA in people with high levels of care and depression in axSpA patients [16,19].…”

“…Provision of health services [4] Comorbidity [14] Physical therapy [9] Income and burden of disease [6] Depressive symptoms and burden of disease [19] Diagnostic delay [18] Provision of health services Extra-articular manifestations Comorbidity The claims data were analysed not only for the PROCLAIR respondents (linking claims and survey data), but also for all insured persons who had one of the three diagnostic codes. Therefore, some analyses refer to the total data set of BARMER insurants (e.g.…”

“…Redeker et al [19] investigated the variables associated with depressive symptoms in respondents with axSpA. In all, 42% of the patients reported good well-being, but 28% showed mild symptoms and 31% moderate to severe depressive symptoms.…”