OP0176-HPR SELF-MANAGEMENT BEHAVIOUR, ANXIETY AND DEPRESSION IN PATIENTS WITH INFLAMMATORY ARTHRITIS - A CROSS SECTIONAL NATIONWIDE STUDY AMONG >12,000 DANISH PATIENTS

Abstract

BackgroundAnxiety and depression are the mental health issues most commonly associated with inflammatory arthritis (IA) and the link between mental health issues and poor health outcomes is well-established [1].European recommendations on self-management in rheumatic and musculoskeletal diseases emphasizes the need to assess mental health regularly [2]. However, little is known about the association between self-management and mental health in IA.ObjectivesTo investigate the prevalence of anxiety and depression in patients with IA and evaluate the association of these mental health issues and self-management behavior.MethodsWe conducted a nationwide cross-sectional study among adult Danish patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) or spondylarthritis (axSpA). Eligible patients were identified through the Danish Rheumatology database DANBIO and received an electronic questionnaire. The questionnaire covered socio-demographics, self-management behavior and mental health status indicated by the Hospital Anxiety and Depression Scale, a 14-item tool with 2 sub-scales assessing symptoms of anxiety and depression. Self-management behavior was indicated by:Adherence to treatmentusing Compliance Questionnaire Rheumatology-5 item,Patient activation in healthcareusing two items from the Patient Activation Measure-13 questionnaire andlevel of physical activitycovering weekly recommendation from WHO and American College of Sports Medicine. Self-management measures were dichotomized into high or low. Questionnaire data were linked to clinical data from DANBIO.The association between low self-management behaviour and mental health status were estimated using multivariable logistic regression with odds ratios (OR).ResultsA total of 42,407 patients with IA were identified; 30% (N=12,715) completed the questionnaire. Non-responders were younger than responders (60 (±16) vs. 62 (±13) years) with a similar gender distribution (p=0.187). The prevalence of anxiety (HADS-A ≥8) was highest for patients with axSpA (34.5% (95% CI; 32.4; 36.6)) and lowest for patients with RA (22.1% (95% CI: 21.2; 23.0)). Prevalence of depression (HADS-D ≥8) was highest for patients with PsA (27.2% (95%CI: 25.4;29.0)) and lowest for patients with RA 18.6% (95%CI: 17.7;19.4). For both anxiety and depression, the prevalence was higher for women, younger (<55 years), newly diagnosed (<3 years) and patients with basic education.Patients having a clinical level (HADS ≥8) of anxiety and depression were more likely to have low self-management behavior for all included self-management measures (Table 1).Table 1.Association between mental health issues and self-management behaviorAdherence to treatmentPatient activation in healthcarePhysical activityCan tell when outpatient care is neededCan handle new situations with health conditionOR (95% CI)*OR (95% CI)*OR (95% CI)*OR (95% CI)*AnxietyHADS-A ≤7RefRefRefRefHADS-A 8-101.22 (1.09;1.36)2.33 (2.03;2.68)2.91 (2.60;3.25)1.32 (1.18; 1.47)HADS-A ≥111.41 (1.24;1.60)4.33 (3.76;4.99)5.72 (5.03;6.50)1.62 (1.42;1.85)DepressionHADS-D ≤7RefRefRefRefHADS-D 8-101.35 (1.20;1.52)2.97 (2.60;3.39)3.91 (3.50;4.38)1.96 (1.74;2.22)HADS-D ≥111.30 (1.12;1.51)4.96 (4.24;5.80)7.09 (6.11;8.22)2.43 (2.06;2.88)*Adjusted for age, sex, education.Ref: reference group, low self-management behaviorConclusionIn this nationwide study, high levels of anxiety and depression were seen among patients with IA. A strong association between anxiety and depression and low self-management behavior was identified. These findings call for a systematic approach in identifying mental health issues in patients with IA.