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Depression high among patients with axial SpA, linked to impairment
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Depression prevalence is high among patients with axial spondyloarthritis, and is associated with disease activity, functional impairment, lower income and lack of exercise, according to findings published in the Annals of the Rheumatic Diseases.
“Psychological distress, including depressive symptoms, is frequently reported in persons with [axial spondyloarthritis (SpA)],” Imke Redeker, MSc, of the German Rheumatism Research Center, and colleagues wrote. “Furthermore, a recent study showed that [ankylosing spondylitis] subjects have an increased risk of developing depressive disorders following their diagnosis.”
To determine the psychological well-being of patients with axial SpA, and to evaluate the links between depression and axial SpA, the researchers drew data from a nationwide health insurance fund in Germany with 6.6 million continuously insured members through 2013 and 2014. Redeker and colleagues mailed a questionnaire to 5,000 randomly selected patients with outpatient claims that included a diagnosis of axial SpA. The survey was designed to assess disease-related, psychological and lifestyle factors, as well as socioeconomic status. Questions also aimed to verify the axial SpA diagnosis.
The researchers determined psychological well-being using the 5-item WHO Well-Being Index (WHO-5). Scores of more than 50 were determined to be “good well-being, no depressive symptoms,” scores of 29 to 50 were labeled “mild depressive symptoms,” and 28 and below was “moderate-to-severe depressive symptoms.” Among the selected 5,000 patients, 4,471 received the survey, 2,118 responded, and 2,082 further consented to the researchers linking their survey and claims data. Of those who consented, Redeker and colleagues were able to confirm axial SpA diagnosis in 1,776, and 1,736 provided valid data for a WHO-5 score.
According to the researchers, of the 1,736 included in the final analysis, 31% were determined to have moderate-to-severe depressive symptoms. In addition, 28% had mild depressive symptoms, and 42% had good psychological well-being. Higher disease activity and functional impairment, as well as lower income, stress, lack of exercise and younger age were associated with moderate-to-severe depression symptoms.
“We found a high prevalence of depressive symptoms/impaired psychological well-being in patients with [axial SpA],” Redeker and colleagues wrote. “Higher [disease activity and functional impairment], the perception of suffering from stress, lack of exercise, lower income level and younger age are factors associated with moderate-to-severe depressive symptoms in patients with [axial SpA] while controlling for other variables. These findings highlight the need for the careful evaluation of depressive symptoms as a part of the management strategy for [axial SpA], helping to improve [axial SpA] outcomes.” – by Jason Laday
Disclosure: The researchers report funding from the Federal Ministry of Education and Research and by the Leibniz Science Campus Chronic Inflammation.
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