The prevalence of depression in axial spondyloarthritis and its association with disease activity: a systematic review and meta-analysis

Zhao, Sizheng Steven; Thong, Daniel; Miller, Natasha; Duffield, Stephen; Hughes, David; Chadwick, Laura; Goodson, Nicola

doi:10.1186/s13075-018-1644-6

Cited by 109 publications

(130 citation statements)

References 37 publications

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“…Depression and fibromyalgia were not described in ASAS-COMOSPA. The prevalence of depression reported in our cohort was very similar to results from a prior meta-analysis in axSpA (16% vs 15%) [25]. Fibromyalgia (5%) was likely under-diagnosed, compared to prevalence reported using meta-analysis (13%) and found by screening questionnaire in the British Society for Rheumatology Biologics Register for AS (21%) [26,27].…”

Section: Discussionsupporting

confidence: 85%

“…Associations between clusters dominated by these two conditions and patient-reported outcome measures were similar in magnitude to those reported in other studies [25][26][27]7]. In previous meta-analysis, depression was additionally associated with objective measures such as ESR and the Bath AS metrology index [25]. Baseline depression has also been shown to reduce treatment response in RA [28] but further studies are needed in axSpA.…”

Section: Discussionsupporting

confidence: 82%

“…Fibromyalgia (5%) was likely under-diagnosed, compared to prevalence reported using meta-analysis (13%) and found by screening questionnaire in the British Society for Rheumatology Biologics Register for AS (21%) [26,27]. Associations between clusters dominated by these two conditions and patient-reported outcome measures were similar in magnitude to those reported in other studies [25][26][27]7]. In previous meta-analysis, depression was additionally associated with objective measures such as ESR and the Bath AS metrology index [25].…”

Section: Discussionsupporting

confidence: 73%

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Comorbidity burden in axial spondyloarthritis: a cluster analysis

et al. 2019

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Objectives To examine how comorbidities cluster in axial spondyloarthritis (axSpA) and whether these clusters are associated with quality of life, global health and other outcome measures. Methods We conducted a cross-sectional study of consecutive patients meeting ASAS criteria for axSpA in Liverpool, UK. Outcome measures included quality of life (EQ5D), global health and disease activity (BASDAI). We used hierarchical cluster analysis to group patients according to 38 pre-specified comorbidities. In multivariable linear models, the associations between distinct comorbidity clusters and each outcome measure were compared, using axSpA patients with no comorbidities as the reference group. Analyses were adjusted for age, gender, symptom duration, BMI, deprivation, NSAID-use and smoking. Results We studied 419 patients (69% male, mean age 46 years). 255 patients (61%) had at least one comorbidity, among whom the median number was 1 (range 1–6). Common comorbidities were hypertension (19%) and depression (16%). Of 15 clusters identified, the most prevalent clusters were hypertension-coronary heart disease and depression-anxiety. Compared with patients with no comorbidities, the fibromyalgia-irritable bowel syndrome cluster was associated with adverse patient-reported outcome measures; these patients reported 1.5-unit poorer global health (95%CI 0.01, 2.9), reduced quality of life (0.25-unit lower EQ5D; 95%CI −0.37, −0.12) and 1.8-unit higher BASDAI (95% CI 0.4, 3.3). Similar effect estimates were found for patients in the depression-anxiety cluster. Conclusion Comorbidity is common among axSpA patients. The two most common comorbidities were hypertension and depression. Patients in the depression-anxiety and fibromyalgia-IBS clusters reported poorer health and increased axSpA severity.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 73%

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Comorbidity burden in axial spondyloarthritis: a cluster analysis

et al. 2019

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“…In their 2018 systematic review, Zhao et al (14) identified 16 studies and reported the prevalence of depression ranging from 11% to 64% and pooled prevalence of 0.29 (95% 10 CI 0.15 to 0.44), which is consistent with secondary outcomes in our current systematic review. The issue of prevalent (or comorbid) depression is particularly important in AS management, given associations with disease activity and functional impairment (14) as well as the diagnosis delay from the symptom onset (26). Equally important is the onset of depression following AS diagnosis and as we demonstrated in our systematic review, there is a 51% higher risk of depression among AS patients compared to individuals without AS.…”

Section: Discussionsupporting

confidence: 84%

“…To our knowledge, this is the first systematic review on the incidence of depression and/or anxiety among patients with AS, which builds on prior systematic reviews on the prevalence of depression in this patient population (14). In their 2018 systematic review, Zhao et al (14) identified 16 studies and reported the prevalence of depression ranging from 11% to 64% and pooled prevalence of 0.29 (95% 10 CI 0.15 to 0.44), which is consistent with secondary outcomes in our current systematic review. The issue of prevalent (or comorbid) depression is particularly important in AS management, given associations with disease activity and functional impairment (14) as well as the diagnosis delay from the symptom onset (26).…”

Section: Discussionmentioning

confidence: 98%

The incidence of depression and anxiety in patients with ankylosing spondylitis: A systematic review and meta-analysis

Park

Howren

Zusman

et al. 2019

Preprint

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Background: As awareness for the importance of mental health continues to expand in rheumatology, it is important to understand the epidemiology of psychiatric complications in ankylosing spondylitis (AS) with the ultimate goal of future prevention and improved quality of care. This study aims to review evidence on the incidence and determinants of depression and/or anxiety among patients with AS. Methods: We searched Medline, Embase, Cochrane Database of Systematic Reviews, CINAHL Complete, and PsycINFO for full-length observational studies that involved a sample or population of patients with AS and assessed depression and/or anxiety. Primary outcomes extracted were: 1) risk estimates for depression and/or anxiety (e.g., relative risk [RR]); and 2) determinants or factors identified as independent predictors of depression and/or anxiety using multivariable regression approaches and corresponding estimates (e.g., odds ratios [OR]). Where relevant, we pooled estimates using random effects models. Results: Out of 783 titles from our search strategy, we reviewed 39 manuscripts. Four studies assessed the incidence of depression and meta-analyzing reported estimates from three of these studies yielded a pooled RR of 1.51 (95% CI 1.28 to 1.79). Differences in risk of depression among men and women with AS were inconclusive, suggesting need for further study. The incidence of anxiety was comparatively less studied with only one included study reporting a hazard ratio of 1.85 (95% CI 1.37 to 2.49). Education level was a key determinant, with lower levels associated with higher odds of depression (OR 6.65; 9% CI 1.36 to 32.51) and anxiety (OR 9.31; 9% CI 1.39 to 62.19) among AS patients. Conclusions: Our systematic review and meta-analysis shows an increased risk of depression and anxiety among patients with AS. These findings suggest the importance of monitoring and care for psychiatric conditions in AS.

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Multidimensional Health Assessment Questionnaire as an Effective Tool to Screen for Depression in Routine Rheumatology Care

Morlà

Castrejón

et al. 2020

Arthritis Care & Research

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Objective. To analyze the use of the Multidimensional Health Assessment Questionnaire (MDHAQ) to screen for depression, as compared to 2 reference standards, the Patient Health Questionnaire 9 (PHQ-9) and the Hospital Anxiety and Depression Scale depression domain (HADS-D). Methods. Patients from Barcelona with a primary diagnosis of rheumatoid arthritis (RA) or spondyloarthritis (SpA) completed the MDHAQ, the PHQ-9 (depression ≥10), and the HADS-D (depression ≥8) measures. The MDHAQ includes 2 depression items, 1 in the patient-friendly HAQ, scored in a 4-point format from 0 to 3.3, and a yes/no item on a 60-symptom checklist. Percentage agreement and kappa statistics quantified the agreement between 6 screening criteria: yes on the 60-symptom checklist, a score of ≥1.1, a score of ≥2.2 on a 4-point scale, and either a response of yes on the 60-symptom checklist or scores of ≥2.2, PHQ-9 ≥10, and HADS-D ≥8. Results. Depression screening was positive according to 6 criteria in 19.6-32.4% of 102 patients with RA, and 27.9-44.8% of 68 with SpA (total = 170). All MDHAQ scores, including depression items, were higher in patients with SpA compared to patients with RA, and within each diagnostic group in patients who met PHQ-9 ≥10 and HADS-D ≥8 depression screening criteria. The highest percentage agreement between an MDHAQ screening criterion versus PHQ-9 ≥10 was 83.3% for either an answer of yes on the 60-symptom checklist or a score of ≥2.2 on a 4-point scale, which we have termed MDHAQ-Dep. The agreement of MDHAQ-Dep versus HADS-D ≥8 was 81.7%, similar to the agreement of PHQ-9 ≥10 versus HADS-D ≥8, which was 82.2%. Kappa measures of agreement were 0.63 for MDHAQ-Dep versus PHQ-9 ≥10, 0.60 for MDHAQ-Dep versus HADS-D ≥8, and 0.62 for PHQ-9 ≥10 versus HADS-D ≥8. Conclusion. A positive MDHAQ-Dep response (either an answer of yes on a 60-symptom checklist or a score of ≥2.2 on a 4-point scale) yielded similar results to PHQ-9 ≥10 or HADS-D ≥8 to screen for depression in these RA and SpA patients.

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The prevalence of depression in axial spondyloarthritis and its association with disease activity: a systematic review and meta-analysis

Cited by 109 publications

References 37 publications

Comorbidity burden in axial spondyloarthritis: a cluster analysis

Comorbidity burden in axial spondyloarthritis: a cluster analysis

The incidence of depression and anxiety in patients with ankylosing spondylitis: A systematic review and meta-analysis

Multidimensional Health Assessment Questionnaire as an Effective Tool to Screen for Depression in Routine Rheumatology Care

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