Skip to main content

Advertisement

SpringerLink
Log in

Sociodemographic and disease-related factors are associated with patient-reported anxiety and depression in spondyloarthritis patients in the Swedish SpAScania cohort

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Anxiety and depression are common among patients with rheumatic diseases. This study aims to explore which factors are associated with self-reported anxiety and depression in a well-defined cohort of spondyloarthritis (SpA) patients. In 2009, 3,711 patients from the SpAScania cohort were sent a postal questionnaire to assess health-related quality of life (HRQoL) and physical and mental functioning. The Hospital Anxiety and Depression Scale measured anxiety (HADS-A) and depression (HADS-D), subscales 0–21, best–worst. HADS ≥8 indicates possible cases of anxiety or depression. One-way ANOVA (p < 0.05) tested for differences among the SpA subtypes in HADS scores. Linear regression analysis adjusted for age, gender, and disease duration was used to test for associations between HADS and independent variables. In total, 2,167 (58 %) patients (52 % females, mean age 55.4 years) returned the questionnaire. In total, 683 (32 %) cases were classified as “possible anxiety” and 305 (14 %) as “possible depression” cases with mean (SD) HADS-A 5.9 (4.3) and HADS-D 4.4 (3.6). There were no differences among the SpA subtypes in HADS-A and HADS-D. HADS-A and HADS-D were associated with lower education, lower physical activity (HADS-D only), chronic pain problems, more fatigue, lower general health, lower HRQoL, lower level of functioning, higher disease activity, and lower self-efficacy. Associations with anxiety and/or depression appear multifactorial in patients with SpA including both personal and disease-related factors. Since these comorbidities are increased in SpA and treatable, they should be screened for in clinical practice, possibly with instruments like the HADS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sieper J, Rudwaleit M, Khan MA et al (2006) Concepts and epidemiology of spondyloarthritis. Best Pract Res Clin Rheumatol 20:401–417

    Article  PubMed  Google Scholar 

  2. Andrianakos A, Trontzas P, Christoyannis F et al (2003) Prevalence of rheumatic diseases in Greece: a cross-sectional population based epidemiological study. The ESORDIG Study. J Rheumatol 30:1589–1601

    PubMed  Google Scholar 

  3. Braun J, Bollow M, Remlinger G et al (1998) Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 41:58–67

    Article  PubMed  CAS  Google Scholar 

  4. Roux CH, Saraux A, Le BE et al (2007) Rheumatoid arthritis and spondyloarthropathies: geographical variations in prevalence in France. J Rheumatol 34:117–122

    PubMed  Google Scholar 

  5. Saraux A, Guillemin F, Guggenbuhl P et al (2005) Prevalence of spondyloarthropathies in France: 2001. Ann Rheum Dis 64:1431–1435

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  6. Haglund E, Bremander AB, Petersson IF et al (2011) Prevalence of spondyloarthritis and its subtypes in southern Sweden. Ann Rheum Dis 70:943–948

    Article  PubMed  CAS  Google Scholar 

  7. Sieper J, Rudwaleit M, Baraliakos X et al (2009) The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 68(Suppl 2):ii1–ii44

    Article  PubMed  Google Scholar 

  8. Dagfinrud H, Kjeken I, Mowinckel P et al (2005) Impact of functional impairment in ankylosing spondylitis: impairment, activity limitation, and participation restrictions. J Rheumatol 32:516–523

    PubMed  Google Scholar 

  9. Van Echteld I, Cieza A, Boonen A et al (2006) Identification of the most common problems by patients with ankylosing spondylitis using the international classification of functioning, disability and health. J Rheumatol 33:2475–2483

    PubMed  Google Scholar 

  10. Geenen R, Newman S, Bossema ER et al (2012) Psychological interventions for patients with rheumatic diseases and anxiety or depression. Best Pract Res Clin Rheumatol 26:305–319

    Article  PubMed  Google Scholar 

  11. Hakkou J, Rostom S, Aissaoui N et al (2011) Psychological status in Moroccan patients with ankylosing spondylitis and its relationships with disease parameters and quality of life. J Clin Rheumatol 17:424–428

    Article  PubMed  Google Scholar 

  12. Martindale J, Smith J, Sutton CJ et al (2006) Disease and psychological status in ankylosing spondylitis. Rheumatology (Oxford) 45:1288–1293

    Article  CAS  Google Scholar 

  13. Baysal O, Durmus B, Ersoy Y et al (2011) Relationship between psychological status and disease activity and quality of life in ankylosing spondylitis. Rheumatol Int 31:795–800

    Article  PubMed  Google Scholar 

  14. Khraishi M, MacDonald D, Rampakakis E et al (2011) Prevalence of patient-reported comorbidities in early and established psoriatic arthritis cohorts. Clin Rheumatol 30:877–885

    Article  PubMed  Google Scholar 

  15. Husted JA, Tom BD, Farewell VT et al (2012) Longitudinal study of the bidirectional association between pain and depressive symptoms in patients with psoriatic arthritis. Arthritis Care Res 64:758–765

    Article  Google Scholar 

  16. McWilliams LA, Clara IP, Murphy PD et al (2008) Associations between arthritis and a broad range of psychiatric disorders: findings from a nationally representative sample. J Pain 9:37–44

    Article  PubMed  Google Scholar 

  17. Englund M, Joud A, Geborek P et al (2010) Prevalence and incidence of rheumatoid arthritis in southern Sweden 2008 and their relation to prescribed biologics. Rheumatology (Oxford) 49:1563–1569

    Article  Google Scholar 

  18. Haglund E, Bergman S, Petersson IF et al (2012) Differences in physical activity patterns in patients with spondyloarthritis. Arthritis Care Res

  19. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    Article  PubMed  CAS  Google Scholar 

  20. Herrmann C (1997) International experiences with the Hospital Anxiety and Depression Scale—a review of validation data and clinical results. J Psychosom Res 42:17–41

    Article  PubMed  CAS  Google Scholar 

  21. Garrett S, Jenkinson T, Kennedy LG et al (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21:2286–2291

    PubMed  CAS  Google Scholar 

  22. Calin A, Garrett S, Whitelock H et al (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21:2281–2285

    PubMed  CAS  Google Scholar 

  23. EuroQol Group (1990) EuroQol—a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy 16:199–208

    Article  Google Scholar 

  24. Hurst NP, Jobanputra P, Hunter M et al (1994) Validity of Euroqol—a generic health status instrument—in patients with rheumatoid arthritis. Economic and Health Outcomes Research Group. Br J Rheumatol 33:655–662

    Article  PubMed  CAS  Google Scholar 

  25. Wolfe F, Smythe HA, Yunus MB et al (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 33:160–172

    Article  PubMed  CAS  Google Scholar 

  26. Bergman S, Herrstrom P, Jacobsson LT et al (2002) Chronic widespread pain: a three year followup of pain distribution and risk factors. J Rheumatol 29:818–825

    PubMed  Google Scholar 

  27. Lorig K, Chastain RL, Ung E et al (1989) Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum 32:37–44

    Article  PubMed  CAS  Google Scholar 

  28. Lomi C, Nordholm LA (1992) Validation of a Swedish version of the Arthritis Self-efficacy Scale. Scand J Rheumatol 21:231–237

    Article  PubMed  CAS  Google Scholar 

  29. Gniadecki R, Robertson D, Molta CT et al (2012) Self-reported health outcomes in patients with psoriasis and psoriatic arthritis randomized to two etanercept regimens. J Eur Acad Dermatol Venereol 26:1436–1443

    Article  PubMed  CAS  Google Scholar 

  30. Lisspers J, Nygren A, Soderman E (1997) Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample. Acta Psychiatr Scand 96:281–286

    Article  PubMed  CAS  Google Scholar 

  31. Bjelland I, Dahl AA, Haug TT et al (2002) The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res 52:69–77

    Article  PubMed  Google Scholar 

  32. Cinar FI, Cinar M, Yilmaz S et al (2013) Thoughts and perceptions of ankylosing spondylitis patients with regard to TNF inhibitors. Rheumatol Int

  33. Haglund E, Bremander A, Bergman S et al (2013) Work productivity in a population-based cohort of patients with spondyloarthritis. Rheumatology (Oxford) 52:1708–1714

    Article  Google Scholar 

  34. Healey EL, Haywood KL, Jordan KP et al (2011) Impact of ankylosing spondylitis on work in patients across the UK. Scand J Rheumatol 40:34–40

    Article  PubMed  CAS  Google Scholar 

  35. Sartorius N, Ustun TB, Lecrubier Y et al (1996) Depression comorbid with anxiety: results from the WHO study on psychological disorders in primary health care. Br J Psychiatry Suppl 30:38–43

    PubMed  Google Scholar 

  36. DiMatteo MR, Lepper HS, Croghan TW (2000) Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 160:2101–2107

    Article  PubMed  CAS  Google Scholar 

  37. Maurer J, Rebbapragada V, Borson S et al (2008) Anxiety and depression in COPD: current understanding, unanswered questions, and research needs. Chest 134:43S–56S

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We would like to thank Fredrik Nilsson and Aleksandra Turkiewicz for statistical support and data management. Funding support was from the Swedish Rheumatism Association, Medical Faculty Lund University, and Region Skåne, Sweden.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Epi-centre Skåne, Skåne University Hospital, Medicon village, SE-223 81, Lund, Sweden

    Jorit J. L. Meesters & Ingemar F. Petersson

  2. Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands

    Jorit J. L. Meesters

  3. Department of Orthopedics, Clinical Sciences, University of Lund, Lund, Sweden

    Ingemar F. Petersson

  4. Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden

    Stefan Bergman, Emma Haglund & Ann Bremander

  5. Spenshult, Research and Development Center, Oskarström, Sweden

    Stefan Bergman, Emma Haglund & Ann Bremander

  6. Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden

    Lennart T. H. Jacobsson

  7. School of Business and Engineering, Department of Exercise Physiology, Biomechanics and Health, Halmstad University, Halmstad, Sweden

    Ann Bremander

Authors
  1. Jorit J. L. Meesters
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ingemar F. Petersson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefan Bergman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emma Haglund
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lennart T. H. Jacobsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ann Bremander
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jorit J. L. Meesters.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Meesters, J.J.L., Petersson, I.F., Bergman, S. et al. Sociodemographic and disease-related factors are associated with patient-reported anxiety and depression in spondyloarthritis patients in the Swedish SpAScania cohort. Clin Rheumatol 33, 1649–1656 (2014). https://doi.org/10.1007/s10067-014-2699-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-014-2699-7

Keywords

Search

Navigation