040 The incidence of anxiety or depression in patients with and without inflammatory rheumatic conditions

Machin, Annabelle R; Hider, Samantha L; Chew-Graham, Carolyn A; Bucknall, Milica

Abstract

Background: Rheumatoid arthritis (RA) has been linked to several co-morbidities, including anxiety and depression, which can contribute to increased morbidity and mortality. Less literature has examined the association between other inflammatory rheumatic conditions (IRCs) and mood problems. The aim of the study was to investigate the association between different IRCs and consulting for anxiety or depression.

Methods: A matched retrospective cohort study was undertaken using data from the Consultations in Primary Care Archive database (CiPCA) comprising of 12 general practices in Staffordshire, the United Kingdom. Individuals aged ⩾18 years with a first ever Read code diagnosis of rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), polymyalgia rheumatica (PMR) or giant cell arteritis (GCA) between 1/1/2001 and 31/12/2015 (index date) were identified and matched on age, gender and practice to four individuals without IRCs. Follow-up was until the end of August 2016. Individuals with a diagnosis of anxiety or depression in the 12 months preceding the index date were excluded. Hazard ratios (HR) were estimated using Cox regression adjusted for obesity, lifestyle characteristics and select co-morbidities. Risk of incident anxiety or depression was assessed at different time points.

Results: The study sample included 1,363 individuals with IRCs (RA = 516, AS = 50, PsA= 73, PMR= 630, GCA= 89) matched to 5054 individuals without IRCs; median follow-up time was 4.8 years. 14.7% of those with an IRC at index and 12.5% of those without had a record of anxiety or depression diagnosis in the follow-up period (p-value=0.030). Incidence rate per 1000 person-years was 24.4 (95%CI 21.2, 28.0) and 21.5 (19.9, 23.2) among those with and without IRCs respectively; adjusted HR 1.10 (0.93, 1.29), although not statistically significant. The risk of incident anxiety or depression in IRCs was highest within the first year following index date (1.26 (0.95, 1.66)). There was an increased risk of anxiety or depression in PMR across all time periods between 0 to 5+ years, also highest within the first year after the index date (1.51 (0.97, 2.35), whilst the risk of mood problems was only increased between 2-5 years in RA patients (1.17 (0.75, 1.81)). Sufficiently large sample sizes could not be obtained to meaningfully compare those with AS, PsA and GCA to their comparison groups.

Conclusion: People with IRCs are at an increased risk of onset of anxiety or depression especially within the first year of diagnosis, suggesting a need for increased awareness of mood problems following a new diagnosis. However, rates of anxiety or depression were lower than expected, perhaps representing a discordance between a patient experiencing symptoms and consulting for mood problems. Clinicians should be aware of the impact of these conditions on mood, especially in people with a recent diagnosis.

• Journal Article Type: Conference Paper
• Online Publication Date: Apr 12, 2019
• Publication Date: Apr 1, 2019
• Deposit Date: Jun 28, 2023
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 58
• Issue: Supplement_3
• DOI: https://doi.org/10.1093/rheumatology/kez106.039
• Keywords: Pharmacology (medical); Rheumatology