A recent study revealed elevated odds of depression and anxiety health care encounters and medication use among individuals with inflammatory arthritis in the 5 years pre- and post-diagnosis, according to research published in Arthritis Care & Research.1 The findings suggest a potential role for depression and anxiety in defining the inflammatory arthritis prodrome, emphasizing the need to explore overlapping biopsychosocial processes linking arthritis and mental health conditions.
Depression and anxiety may be more prevalent in this patient population due to a mix of biological, psychological, and social factors. For example, tender and swollen joints, fatigue, and joint destruction have been previously indicated as psychiatric comorbidities. Adjustment to illness, including the daily struggle of coping with a relatively invisible disease, can also elevate a patient’s predisposition for depression and anxiety.2
“The complexity of factors contributing to the comorbid nature of depression and anxiety with inflammatory arthritis perhaps influences the present challenge with delineating temporality,” wrote Alyssa Howren, MSc, Faculty of Pharmaceutical Sciences, University of British Columbia, Canada, and colleagues. “Opportunities to expand knowledge on the relationship of mental disorders with inflammatory arthritis include: analysis of less studied patient populations, namely ankylosing spondylitis (AS) and psoriatic arthritis (PsA); evaluation of anxiety as a primary outcome given evidence has largely focused on depression; and assessment of health care use for anxiety and depression in terms of clinical encounters and medication use.”
Population-based linked administrative health data from British Columbia, Canada, were used to identify a cohort of adult patients with incident inflammatory arthritis, including rheumatoid arthritis (RA), PsA, and AS, as well as age- and sex-matched controls without arthritis (IAfree controls). Investigators assessed the proportion of patients with inflammatory arthritis and controls with ≥1 depression or ≥1 anxiety health care encounter and use of ≥1 antidepressant or ≥1 anxiolytic annually 5 years pre- and post-arthritis diagnosis. The link between inflammatory arthritis and depression and anxiety outcomes were determined using multivariable logistic regression models.
A total of 80,238 patients with inflammatory arthritis and 80,238 IAfree controls were included in the analysis. The mean age was 56.2 years and 62.9% were female.
Patients with inflammatory arthritis demonstrated significantly increased odds of depression and anxiety health care encounters and use of anxiolytics and antidepressants for each year pre- and post-diagnosis. The adjusted odds ratios (aORs) were the highest immediately before (≥1 depression visit: aOR 1.61, 95% confidence interval [CI] 1.55 — 1.66; ≥1 anxiolytic: aOR 1.71, 95% CI 1.66 — 1.77) or immediately after (≥1 antidepressant: aOR 1.95, 95% CI 1.89 — 2.00) the arthritis diagnosis.
Investigators noted limitations including the lack of generalizability to populations without publicly funded health care. Additionally, the data reflects patients with access to medical care. The data obtained from the Population Data BC do not include privately funded health care, such as psychology and counseling. Lastly, there is a possibility of unmeasured confounding due to a lack of variables which measure the psychosocial determinants of health, such as marital status, education level, and fatigue.
“Designing an analysis focused on health care encounters and medications for depression and anxiety provides detailed insight into their bidirectional relationship with inflammatory arthritis, and the consistently higher use observed in individuals with inflammatory arthritis over the 10-year observation period warrants future analyses to deduce whether it is truly elevated or if there are alternative explanations, such as misdiagnosis or a tendency to diagnose mild depression and anxiety among individuals with inflammatory arthritis,” investigators concluded.
References
- Howren A, Sayre EC, Avina-Zubieta JA, et al. "What came first?" Population-based evaluation of health care encounters for depression and anxiety before and after inflammatory arthritis diagnosis: Disentangling the relationship between mental health and arthritis. Arthritis Care Res (Hoboken). Published online January 8, 2024. doi:10.1002/acr.25294
- Sumner LAN, P.M. . The importance of the biopsychosocial model for understanding the adjustment to arthritis. In: Nicassio PM, editor. Psychosocial Factors in Arthritis. Switzerland: Springer; 2016.
