Anxiety, depression jeopardize health of axSpA patients

Patients with axial spondyloarthritis (axSpA) may experience a decline in their overall health and functioning due to the presence of comorbid anxiety and depression, as reported in a study from Singapore.

Higher Hospital Anxiety and Depression Scale (HADS) scores (≥8 to <11 and ≥11 to <21 indicating borderline and abnormal levels of anxiety or depression, respectively) were associated with poorer overall health and functioning as defined by higher Assessment of SpondyloArthritis International Society Health Index (ASAS HI) scores (p≤0.01). [BMJ Open 2023;13:e071944]

Meanwhile, the level of resilience as measured by the 10-item Connor Davidson Resilience Scale (CD-RISC-10) was not associated with ASAS HI scores (p=0.43). Interaction terms between resilience and anxiety and between resilience and depression were not significant (p=0.796 and p=0.934, respectively).

Factors such as pain, fatigue, and functional impairment have been reported as major drivers of psychological issues, including anxiety and depression, in axSpa. This, according to the investigators, may explain the link between higher levels of anxiety and depression and poorer health. [Patient Prefer Adherence 2016;10:879-885; Clin Rheumatol 2018;37:407-414; Joint Bone Spine 2013;80:393-398]

“Anxiety and depression were also found to impair treatment responses, which might imply reciprocal effects between anxiety and depression with disease activity,” they added. [Rheumatology 2021;60:5734-5742]

Screening for psychological problems

In light of the findings of the present study, the investigators emphasized the need for clinicians to be aware and screen for the presence of anxiety and depression in patients with axSpA, especially since mental health conditions are often underdiagnosed. [Ann Intern Med 2007;146:317-325; JAMA 2003;289:3145-3151]

“Clinicians should also factor in possible anxiety and depression when interpreting disease activities,” they said.

The study included 296 patients (median age of 41.0 years, 76.0 percent men, 92.6 percent Chinese) with axSpa, with a median disease duration of 9.0 years. The median Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) scores were 2.2 and 1.1, respectively.

The median score for HADS anxiety was 5.0, with 40 (13.5 percent) and 41 (13.9 percent) patients having borderline and abnormal levels of anxiety, respectively. On the other hand, the median score for HADS depression was 3.0, with 38 (12.8 percent) and 25 (8.4 percent) patients having borderline and abnormal levels of depression, respectively.

Most of the patients had good functioning (n=176, 59.5 percent), and only 18 (6.1 percent) had poor functioning. The median score for CD-RISC-10 and ASAS HI were 29.0 and 4.0, respectively.