POS0505 DEPRESSION, ANXIETY AND STRESS AMONG OUTPATIENTS WITH RHEUMATOID ARTHRITIS FOLLOWED UP AT A TERTIARY CARE HOSPITAL IN SRI LANKA; A CROSS-SECTIONAL STUDY

Abstract

Background:Increased prevalence of depression, anxiety and stress have been shown among patients with rheumatoid arthritis. Patient and disease characteristics and psychosocial factors associated with these mental health issues are shown to vary among different populations. South Asian studies comprehensively assessing the prevalence and associations of these factors are lacking.Objectives:To determine the prevalence of depression, anxiety and stress among patients with rheumatoid arthritis and to identify associated patient and disease factors.Methods:A cross-sectional study was carried out among outpatients at three specialized rheumatology clinics at the National Hospital of Sri Lanka. Individuals with a diagnosis of rheumatoid arthritis were recruited consecutively. An interviewer-administered questionnaire was used to record sociodemographic and clinical data including the Clinical Disease Activity Index. A score 10.1-22.0 was taken as moderate and more than 22.1 was taken as high disease activity. The self-administered Depression, Anxiety, Stress Scale-21 (DASS-21) tool which has been validated for the Sri Lankan population was used. Statistical analysis was done using descriptive analysis and Chi-Square.Results:A total of 118 participants were recruited in this study. Majority of the participants (n=105) were female and had received a secondary school education (70%). Based on the CDAI assessment most were in the moderate (39%) and high disease activity groups (36%). Prevalence of Depression, Anxiety and Stress were found to be higher than the baseline level of 1% in the general population. A breakdown of the prevalence is shown in Figure 1. Further analysis of each arm, depression anxiety and stress were carried out independently excluding the non-responders. A higher level of prevalence of all three parameters was observed with the deterioration of functional status evidenced by the inability to walk and grip a ball firmly in the palm without it falling. Prevalence of depression was associated with age > 60 years (p=0.035), increased disease activity (p=0.004) and the loss of their job due to poor health (p=0.01). Higher prevalence of anxiety was associated with increased disease activity (p=0.023). A marked increase in stress level was associated with loss of the job (p=0.009) and morning stiffness > 60 minutes (p=0.001). Several Pre-existing co-morbidities were associated with depression and anxiety (Table 1). No association was observed between stress and pre-existing comorbidities.Table 1.Correlation of comorbidities with depression and anxiety.Associated FactorsDepressionAnxietyYesNoYesNoDiabetes Mellitus (%)Identified18(72)07(28)16(66)08(34)Not Identified37(45)46(55)46(55)38(45)P-value0.0160.298Ischaemic heart disease (%)Identified14(82)03(18)14(78)04(22)Not Identified41(45)50(55)48(53)42(47)P-value0.0050.056Dyslipidaemia (%)Identified20(67)10(33)25(78)07(22)Not Identified35(45)43(55)37(49)39(51)P-value0.0420.005Figure 1.Prevalence of depression, anxiety and stress among patients with rheumatoid arthritisConclusion:Prevalence of depression, anxiety and stress among patients with rheumatoid arthritis is higher than the general population. Functional deterioration, disease activity and presence of co-morbidities are associated with these mental health issues. These can guide clinicians to screen high risk individuals for the mental health issues so that measures to relieve them would potentially improve quality of life and disease outcome.Acknowledgements:the authors thank the consultants in charge of the Rheumatology Clinics of the National Hospital, Drs. Jeewani Rubasingha, Monica De Silva and Gunendrika Kasthurirathna. We greatly appreciate the assistance given by the staff of the Department of Community Medicine, Faculty of Medicine, University of Colombo.Disclosure of Interests:None declared