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Howren, Alyssa

University of British Columbia

Objectives: Provide evidence to disentangle the complex relationship between depression and anxiety with inflammatory arthritis (IA) and conduct a comprehensive evaluation of how individuals with IA are treated for comorbid mental disorders. Methods: Four complementary data sources were used: 1) evidence synthesis; 2) population-based administrative health data (Population Data BC); 3) open-source data (Canadian Community Health Survey – Mental Health); and 4) original data (international survey). Descriptive statistics were applied to quantify psychosocial outcomes and describe patterns of health care encounters and treatments for depression and anxiety. Multivariable logistic and linear regression models were used to evaluate associations with outcomes of interest. Results: 1) Numerous case definitions for identifying depression and anxiety using administrative data were applied across the 36 studies in rheumatic diseases synthesized, and case definitions were often unvalidated (83.3%) and insufficiently reported (33.3%). 2a) Health care encounters and medications for depression and anxiety were significantly elevated for individuals with IA during the 5-years before and 5-years after IA diagnosis, as compared to IA-free controls. Odds were highest in the year immediately before (≥1 depression visit: aOR 1.61, 95% CI 1.55-1.66; ≥1 anxiolytic: aOR 1.71, 95% CI 1.66-1.77) or after (≥1 antidepressant: aOR 1.95, 95% CI 1.89-2.00) IA diagnosis. 2b) Half of individuals with IA were receiving minimally adequate pharmacotherapy (depression: 50.5%; anxiety: 46.9%) and one-fifth were receiving adequate psychological treatment (depression: 19.6%; anxiety: 20.2%) for their incident mental disorder, findings that did not significantly differ from IA-free controls (depression: pharmacotherapy – aOR 1.10, 95% CI 1.00-1.21; psychological – aOR 1.07, 95% CI 0.94-1.21). 3) Individuals with arthritis and a comorbid mental disorder have a greater perceived need for mental health care compared to individuals without arthritis (aOR 1.71, 95% CI 1.06-2.77). 4) Symptoms of loneliness and social isolation were respectively experienced by 51% and 30% of individuals with rheumatic diseases and together associated with significantly higher depression (ß= 7.27; 95% CI 6.08-8.47) and anxiety scores (ß = 5.14; 95% CI: 4.00-6.28). Conclusions: Collectively, these findings have addressed critical gaps in rheumatology literature and provide meaningful clinical implications for improving the mental health of people living with IA.

Text

2025-01-31

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/87340

Pharmaceutical Sciences

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/