Prevalence of anxiety and depression and the association with self-management behaviour in &gt;12 000 patients with inflammatory rheumatic disease: a cross-sectional nationwide study

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Abstract

Objective

To investigate the prevalence of anxiety and depression among patients with inflammatory arthritis (IA) and evaluate the association of these mental health issues with self-management behaviour.

Methods

In this nationwide cross-sectional study, we analysed data from 12 713 adult Danish patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) or spondyloarthritis (SpA). Patients received an electronic questionnaire covering sociodemographics, self-management behaviour and mental health status. Questionnaire data were linked to clinical data from the Danish Rheumatology database (DANBIO) and the Danish National Patient Registry. The prevalence of anxiety and depression (by the Hospital Anxiety and Depression Scale for Anxiety (HADS-A) and Depression (HADS-D)) was estimated separately for RA/PsA/SpA. The association between mental health status and low self-management behaviour (adherence to treatment, health activation and physical activity) was estimated using multivariable logistic regression, adjusting for age, sex, educational level and comorbidity.

Results

The prevalence of anxiety (HADS-A≥8) was highest for patients with SpA (34.5% (95% CI 32.4% to 36.6%)) and lowest for patients with RA (22.1% (95% CI 21.2% to 23.0%)), it was higher for women, younger (<55 years) and recently diagnosed (<3 years) patients and those with basic education. Similar prevalence estimates were found for depression. Across diagnoses, the clinically relevant symptoms of anxiety and depression (HADS≥8) were significantly associated with low self-management behaviour.

Conclusion

Patients with IA showed substantial levels of anxiety and depression. A statistically significant association between anxiety and depression and low self-management behaviour was identified. These findings call for a systematic approach to identifying mental health issues in patients with IA.

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Most cited references 46

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A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation

Mary Charlson, Peter Pompei, Kathy Ales … (1987)

The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.

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The hospital anxiety and depression scale.

A Zigmond, R P Snaith (1983)

A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.

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American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.

Carol Ewing Garber, Bryan Blissmer, Michael R. Deschenes … (2011)

The purpose of this Position Stand is to provide guidance to professionals who counsel and prescribe individualized exercise to apparently healthy adults of all ages. These recommendations also may apply to adults with certain chronic diseases or disabilities, when appropriately evaluated and advised by a health professional. This document supersedes the 1998 American College of Sports Medicine (ACSM) Position Stand, "The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults." The scientific evidence demonstrating the beneficial effects of exercise is indisputable, and the benefits of exercise far outweigh the risks in most adults. A program of regular exercise that includes cardiorespiratory, resistance, flexibility, and neuromotor exercise training beyond activities of daily living to improve and maintain physical fitness and health is essential for most adults. The ACSM recommends that most adults engage in moderate-intensity cardiorespiratory exercise training for ≥30 min·d on ≥5 d·wk for a total of ≥150 min·wk, vigorous-intensity cardiorespiratory exercise training for ≥20 min·d on ≥3 d·wk (≥75 min·wk), or a combination of moderate- and vigorous-intensity exercise to achieve a total energy expenditure of ≥500-1000 MET·min·wk. On 2-3 d·wk, adults should also perform resistance exercises for each of the major muscle groups, and neuromotor exercise involving balance, agility, and coordination. Crucial to maintaining joint range of movement, completing a series of flexibility exercises for each the major muscle-tendon groups (a total of 60 s per exercise) on ≥2 d·wk is recommended. The exercise program should be modified according to an individual's habitual physical activity, physical function, health status, exercise responses, and stated goals. Adults who are unable or unwilling to meet the exercise targets outlined here still can benefit from engaging in amounts of exercise less than recommended. In addition to exercising regularly, there are health benefits in concurrently reducing total time engaged in sedentary pursuits and also by interspersing frequent, short bouts of standing and physical activity between periods of sedentary activity, even in physically active adults. Behaviorally based exercise interventions, the use of behavior change strategies, supervision by an experienced fitness instructor, and exercise that is pleasant and enjoyable can improve adoption and adherence to prescribed exercise programs. Educating adults about and screening for signs and symptoms of CHD and gradual progression of exercise intensity and volume may reduce the risks of exercise. Consultations with a medical professional and diagnostic exercise testing for CHD are useful when clinically indicated but are not recommended for universal screening to enhance the safety of exercise.

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Author and article information

Journal

Journal ID (nlm-ta): RMD Open

Journal ID (iso-abbrev): RMD Open

Journal ID (hwp): rmdopen

Journal ID (publisher-id): rmdopen

Title: RMD Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2056-5933

Publication date Collection: 2024

Publication date (Electronic): 22 January 2024

Volume: 10

Issue: 1

Electronic Location Identifier: e003412

Affiliations

[1 ]departmentDepartment of Rheumatology , Ringgold_11297Aarhus University Hospital , Aarhus, Denmark

[2 ]departmentDANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics , Ringgold_70590Copenhagen University Hospital Glostrup , Glostrup, Denmark

[3 ]departmentDepartment of Clinical Medicine , Ringgold_53139University of Copenhagen Faculty of Health and Medical Sciences , Copenhagen, Denmark

[4 ]departmentCentre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup , Ringgold_70590Copenhagen University Hospital Glostrup , Glostrup, Denmark

[5 ]Patient Research Partner , Aarhus, Denmark

[6 ]Patient Research Partner , London, UK

[7 ]departmentCenter for Clinical Research and Prevention , Ringgold_572755Frederiksberg University Hospital Center for Clinical Research and Prevention , Frederiksberg, Denmark

[8 ]Novo Nordisk A/S , Søborg, Denmark

[9 ]departmentDepartment of Clinical Medicine , Ringgold_53154University of Aarhus Faculty of Health , Aarhus, Denmark

Author notes

[Correspondence to ] Sofie Bech Vestergaard; sofive@ 123456rm.dk

Author information

Sofie Bech Vestergaard http://orcid.org/0009-0000-0456-0230

Bente Appel Esbensen http://orcid.org/0000-0001-5331-8221

Julie Midtgaard Klausen http://orcid.org/0000-0003-2381-2127

Bente Glintborg http://orcid.org/0000-0002-8931-8482

Mette Aadahl http://orcid.org/0000-0001-5904-9747

Pernille Fevejle Cromhout http://orcid.org/0000-0002-0745-959X

Annette de Thurah http://orcid.org/0000-0003-0103-4328

Article

Publisher ID: rmdopen-2023-003412

DOI: 10.1136/rmdopen-2023-003412

PMC ID: 10806500

PubMed ID: 38253596

SO-VID: cdb0f780-ec5a-4d90-a0a0-82d1729da3c1

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 17 June 2023

Date accepted : 03 January 2024

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100008368, Gigtforeningen;

Award ID: R190-A7032

Funded by: FundRef http://dx.doi.org/10.13039/501100005275, Region Hovedstaden;

Award ID: A6855

Funded by: FundRef http://dx.doi.org/10.13039/501100003554, Lundbeck Foundation;

Funded by: FundRef http://dx.doi.org/10.13039/501100009708, Novo Nordisk Fonden;

Award ID: NNF19OC0056658

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Keywords: health services research,arthritis,epidemiology,outcome assessment, health care

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Keywords: health services research, arthritis, epidemiology, outcome assessment, health care

Prevalence of anxiety and depression and the association with self-management behaviour in >12 000 patients with inflammatory rheumatic disease: a cross-sectional nationwide study

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The Physician

Most cited references 46

A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation

The hospital anxiety and depression scale.

American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.

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