The incidence of depression and anxiety in patients with ankylosing spondylitis: A systematic review and meta-analysis

Abstract

Background: As awareness for the importance of mental health continues to expand in rheumatology, it is important to understand the epidemiology of psychiatric complications in ankylosing spondylitis (AS) with the ultimate goal of future prevention and improved quality of care. This study aims to review evidence on the incidence and determinants of depression and/or anxiety among patients with AS. Methods: We searched Medline, Embase, Cochrane Database of Systematic Reviews, CINAHL Complete, and PsycINFO for full-length observational studies that involved a sample or population of patients with AS and assessed depression and/or anxiety. Primary outcomes extracted were: 1) risk estimates for depression and/or anxiety (e.g., relative risk [RR]); and 2) determinants or factors identified as independent predictors of depression and/or anxiety using multivariable regression approaches and corresponding estimates (e.g., odds ratios [OR]). Where relevant, we pooled estimates using random effects models. Results: Out of 783 titles from our search strategy, we reviewed 39 manuscripts. Four studies assessed the incidence of depression and meta-analyzing reported estimates from three of these studies yielded a pooled RR of 1.51 (95% CI 1.28 to 1.79). Differences in risk of depression among men and women with AS were inconclusive, suggesting need for further study. The incidence of anxiety was comparatively less studied with only one included study reporting a hazard ratio of 1.85 (95% CI 1.37 to 2.49). Education level was a key determinant, with lower levels associated with higher odds of depression (OR 6.65; 9% CI 1.36 to 32.51) and anxiety (OR 9.31; 9% CI 1.39 to 62.19) among AS patients. Conclusions: Our systematic review and meta-analysis shows an increased risk of depression and anxiety among patients with AS. These findings suggest the importance of monitoring and care for psychiatric conditions in AS.

Circulatory Cytokines and Chemokines Profile in Human Coronaviruses: A systematic review and meta-analysis

“…Methodological quality and risk of bias were assessed using the Newcastle Ottawa Scale for Observational Studies (28), which was modified to meet the requirement of this study (29). A total of six criteria were evaluated: representativeness of the population, sample size, statistical analysis, missing data, methodology to report the outcome of interest and methods to detect or report the outcome of interest.…”

Depression in patients with spondyloarthritis: prevalence, incidence, risk factors, mechanisms and management

“…Three systematic literature reviews and meta-analyses on the prevalence of depression in AS and PsA are reported. 31,37,38 The largest meta-analysis included 19,263 patients with AS from 33 studies conducted in Europe, Asia and South America. These studies measured depression using a variety of methods including self-report, validated questionnaires, clinical interviews, administrative and hospital records.…”

“…In one meta-analysis, the pooled prevalence of depression in AS was reported to be 29%. 37 However, findings from this meta-analysis were largely driven by one large study from Taiwan comprising 11,701 patients, 39 which used the Elixhauser comorbidity index to record ICD-9 identified diagnoses of depression, 40 rather than direct assessment of mood using a validated scale/interview. Reliance on clinical diagnosis can lack temporal validity, provides no information on current symptom severity, and may underestimate prevalence due to subthreshold and undiagnosed depression.…”

“…With regards to incidence of depression in patients with AS and PsA, two recent systematic literature review and meta-analyses compared incidence of depression in these patient groups with that in healthy populations. 37,44 Comprising 5947 patients with AS from three studies conducted in Taiwan, Sweden and the United States (US), a pooled rate ratio (RR) for depression in AS was 1.51 (95% CI, 1.28–1.79). 37 This 51% increase in risk was calculated based on studies that report incidence rates within 1 year, 45 10 years, 46 and 13 years of developing AS.…”

“…37,44 Comprising 5947 patients with AS from three studies conducted in Taiwan, Sweden and the United States (US), a pooled rate ratio (RR) for depression in AS was 1.51 (95% CI, 1.28–1.79). 37 This 51% increase in risk was calculated based on studies that report incidence rates within 1 year, 45 10 years, 46 and 13 years of developing AS. 47 Smoking and lower education were reported to be associated with a higher risk of depression.…”