Impact of axial spondyloarthritis on mental health in Europe: results from the EMAS study

Abstract

ObjectiveTo determine the presence of mental disorder risk and associated factors in European patients with axial spondyloarthritis (axSpA).MethodsData from 2,166 patients with axSpA in 12 European countries were collected from 2017 to 2018 through the European Map of Axial Spondyloarthritis online survey. Risk of mental disorders was assessed using the 12-item General Health Questionnaire. Possible predictors included age, gender, relationship status, patient organisation membership, job status, educational level, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional limitation (0–54) and self-reported depression or anxiety. Bivariate analyses were conducted to determine predictors of risk of mental disorders (Mann-Whitney and χ2) and multivariable analysis identified factors associated with risk of mental disorders.Results60.7% of patients reported risk of mental disorders: they were younger (41.7 vs 46.0 years), more likely female (68.2% vs 57.9%), unemployed (7.5% vs 2.7%), on temporary (15.9% vs 5.4%) or permanent sick leave (13.2% vs 8.0%), reported depression (45.2% vs 14.2%) or anxiety (41.3% vs 12.5%), higher disease activity (BASDAI ≥4; 87.6% vs 62.3%) and functional limitation (16.5 vs 10.8). The factors most associated with risk of mental disorders were disease activity (OR=2.80), reported depression (OR=2.42), anxiety (OR=2.39), being unemployed or on sick leave (OR=1.98), functional limitation (OR=1.02) and younger age (OR=0.97).ConclusionsCompared with the general population, patients with axSpA show disproportionately worse mental health associated mainly with disease activity and employment status. Healthcare professionals should pay close attention to patients with high disease activity and address internally or refer to specialist services, where appropriate to ensure optimal patient outcomes.

The International Map of Axial Spondyloarthritis Survey: A US Patient Perspective on Diagnosis and Burden of Disease

“…Additionally, the negative impact that axSpA can have on mental health has been reported in other studies and is corroborated with the findings presented in this US cohort (15,36,37). In line with prior studies, a high proportion of patients in this US cohort reported psychological distress (GHQ‐12 score ≥3; 57.0%), depression (42.5%), and anxiety (41.2%).…”

“…The International Map of Axial Spondyloarthritis (IMAS) survey is an initiative developed to generate insights on patientreported aspects of disease burden and experience with axSpA through adaptations of the original Atlas of axSpA questionnaire, which was developed in collaboration with patients, the Axial Spondyloarthritis International Federation, and academic clinical experts (14). Prior studies using an adaptation of the IMAS survey have described the impact of axSpA on patients' lives across 13 European countries (14)(15)(16); however, the US health care system is unique among systems around the world and may have a distinct effect on the patient journey with axSpA. The IMAS survey applied in this study was adapted to capture how patients with axSpA experience the physical, psychological, social, and employment aspects of the disease and how they are managed within and challenged by the segmented US health care system.…”

Efficacy and safety of bimekizumab in axial spondyloarthritis: results of two parallel phase 3 randomised controlled trials

“…starting in patients' mid-20s, 5 axSpA has a significant and lasting impact on patient lives [6][7][8] and a high disease burden. 3 Many patients with axSpA fail treatment, do not achieve treatment targets or experience residual symptoms, [9][10][11] demonstrating the need for more treatment options with novel modes of action.…”

The influence of alexithymia on disease activity and quality of life in patients with axial spondyloarthritis: A cross‐sectional study

“…Chronic inflammation due to the disease nature could put patients at about a 70% risk of mental health disorders, as recently reported in European countries 43 . Inadequate regulation of emotions, known as alexithymia, may predispose individuals to psychological and somatic symptoms 13 .…”

“…42 Chronic inflammation due to the disease nature could put patients at about a 70% risk of mental health disorders, as recently reported in European countries. 43 Inadequate regulation of emotions, known as alexithymia, may predispose individuals to psychological and somatic symptoms. 13 As mentioned above, psychological disorders, such as depression and anxiety, are closely association with alexithymia, 19,22,44 and they are also frequently observed in axSpA patients.…”