Lack of adequate mental health care in inflammatory arthritis ‘needs to be addressed’
Key takeaways:
- A significant amount of patients with inflammatory arthritis did not receive minimally adequate treatment for depression or anxiety.
- Patients without inflammatory arthritis were also undertreated.
Depression and anxiety among patients with inflammatory arthritis is significantly undertreated, with large proportions not receiving minimally adequate care, according to data published in Arthritis Research & Therapy.
“Although the physical effects of arthritis are well-known and often devastating, the impact on mental health has received far less attention,” Mary A. De Vera, PhD, associate professor at the University of British Columbia, and senior scientist at Arthritis Research Canada, told Healio. “This is a gap that needs to be addressed, given the complex relationship between arthritis and psychiatric conditions, with inflammation playing a key underlying role.”
To examine mental health care use among patients with inflammatory arthritis, and determine whether they receive minimally adequate treatment, De Vera and colleagues used administrative health data from a Canadian database, Population Data BC. The analysis included more than 10,000 patients with inflammatory arthritis — either ankylosing spondylitis, psoriatic arthritis or rheumatoid arthritis — who, after their diagnosis, were also diagnosed with depression (n = 6,951; mean age, 54.8 years; 65.5% women) or anxiety (n = 3,701; mean age, 52.9 years; 74.3% women). The study was part of a PhD thesis by one of De Vera’s students, Alyssa Howren, PhD, now a post-doctoral fellow at Stanford University.
Using multivariable logistic regression, the researchers compared patients’ odds of receiving minimally adequate pharmacological or psychological care with those of an equal number of control patients who had depression or anxiety but did not have inflammatory arthritis. Minimally adequate pharmacotherapy was defined as the dispensation of at least 84 days’ supply of antidepressants within a year of diagnosis with either depression or anxiety. Minimally adequate psychological treatment meant at least four sessions of counseling or psychotherapy within 12 months of either diagnosis.
According to the researchers, 50.5% of patients with inflammatory arthritis received minimally adequate pharmacotherapy for depression, and 19.6% received minimally adequate psychological treatment. The findings were similar for patients with anxiety, with 46.9% receiving minimally adequate pharmacological treatment and 20.2% receiving minimally adequate psychological treatment.
Compared with the control patients, those with inflammatory arthritis had similar odds of minimally adequate pharmacotherapy (adjusted OR = 1.1; 95% CI, 1-1.21) and psychological treatment (adjusted OR = 1.07; 95% CI, 0.94-1.21).
“As mental health often receives less attention, and it's well-documented that mental health issues are frequently undertreated, these findings are not necessarily surprising,” De Vera said. “However, we were somewhat surprised with findings of no meaningful difference between inflammatory arthritis and inflammatory arthritis-free controls with respect to minimally adequate mental health treatment for depression and anxiety, as we had hypothesized that patients with IA may receive more mental health care, given their frequent contacts with the health care system, which may facilitate access.”
Next, De Vera said her research team is looking to “explore how to address specific barriers to mental health care for individuals with arthritis.”
“These include the focus on physical rather than mental health, stigma, poor continuity of care, short appointment durations and concerns about medication interactions,” she added.
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