Determinants of psychological well-being in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data

• Published in: Annals of the rheumatic diseases Vol. 77; no. 7; pp. 1017 - 1024
• Main Authors: Redeker, Imke, Hoffmann, Falk, Callhoff, Johanna, Haibel, Hildrun, Sieper, Joachim, Zink, Angela, Poddubnyy, Denis
• Format: Journal Article
• Language: English
• Published: England Elsevier Limited 01.07.2018; BMJ Publishing Group
• Series: Extended report
• Subjects: Adult; Age; Age Factors; Aged; Analgesics; Arthritis; Back pain; Clinical and Epidemiological Research; Cohort Studies; Depression - epidemiology; Depression - etiology; Depression - physiopathology; Diagnosis; Disability Evaluation; Female; Germany; Health services; Humans; Inflammatory bowel disease; Inflammatory diseases; Logistic Models; Male; Mental depression; Middle Aged; Multivariate Analysis; Narcotics; Patient Reported Outcome Measures; Patients; Prognosis; Psoriasis; Quality of Life; Questionnaires; Rheumatic diseases; Rheumatoid arthritis; Rheumatology; Risk Assessment; Sacroiliac Joint; Severity of Illness Index; Sex Factors; Sickness Impact Profile; Socioeconomic factors; Spondylarthritis - diagnosis; Spondylarthritis - psychology; Spondylitis, Ankylosing - diagnosis; Spondylitis, Ankylosing - psychology; Studies; Surveys and Questionnaires; Well being; Germany; well-being; axial spondyloarthritis; depression
• ISSN: 0003-4967; 1468-2060; 1468-2060
• DOI: 10.1136/annrheumdis-2017-212629

ObjectivesThe aim of this study was to assess the psychological well-being and to analyse factors associated with depressive symptoms in axial spondyloarthritis (axSpA).MethodsA stratified random sample of subjects with a diagnosis of axSpA (International Classification of Diseases, Tenth Revision, German Modification M45) was drawn from health insurance data in Germany. These persons received a postal questionnaire on disease-related, psychological and lifestyle factors as well as socioeconomic status. Additional information to verify the axSpA diagnosis was also collected. The psychological well-being was assessed by means of the 5-item WHO Well-Being Index (WHO-5), which is considered a screening tool for depression. The following established cut-offs on the WHO-5 were applied: >50: good well-being, no depressive symptoms; 29–50: mild depressive symptoms; ≤28: moderate-to-severe depressive symptoms. Information on comorbidities, drug prescriptions and non-pharmacological treatment was retrieved from claims data and linked to the questionnaire data.ResultsA total of 1736 persons with a confirmed axSpA diagnosis were included. Using the cut-offs on the WHO-5, 533 persons (31%) were found to have moderate-to-severe depressive symptoms, 479 (28%) had mild depressive symptoms and 724 (42%) had a good well-being. Multivariable logistic regression revealed that higher disease activity, higher level of functional impairment, lower income, self-reported stress and lack of exercise, and younger age represent factors associated with moderate-to-severe depressive symptoms.ConclusionsThe prevalence of depressive symptoms in axSpA subjects is high and associated with disease-related parameters, socioeconomic status and lifestyle factors. These findings highlight the need for the careful evaluation of depressive symptoms as a part of the management strategy for axSpA.