The prevalence of depression in axial spondyloarthritis and its association with disease activity: a systematic review and meta-analysis

Sizheng Zhao,Nicola J Goodson,Natasha Miller,Laura Chadwick,David M Hughes,Stephen J Duffield,Daniel Thong

doi:10.1186/s13075-018-1644-6

Sizheng Zhao, Nicola J Goodson + Show 5 more

Open Access

https://doi.org/10.1186/s13075-018-1644-6

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Abstract

BackgroundDepression is common among patients with axial spondyloarthritis (axSpA), but reports of its prevalence are highly variable. We performed a systematic review to (i) describe the prevalence of depression in axSpA, (ii) compare its prevalence between axSpA, ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA) cohorts, and (iii) compare disease activity and functional impairment between those with and without depression.MethodsWe searched Medline, PubMed, Web of Science, PsycINFO, CINAHL Plus, the Cochrane library and conference abstracts of the European League Against Rheumatism, British Society for Rheumatology and American College of Rheumatology using a predefined protocol in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Meta-analysis was performed using quality-effects model.ResultsFifteen original articles and one abstract were included for analysis; 14 studies described AS cohorts and two nr-axSpA. Three screening criteria and one diagnostic criterion were used to define depression. Prevalence ranged from 11 to 64% depending on criteria and thresholds used. Pooled prevalence of at least moderate depression was 15% using the Hospital Anxiety and Depression Scale (HADS) threshold of ≥ 11. The prevalence of depression was similar between axSpA, AS and nr-axSpA cohorts. Patients with depression had significantly worse disease activity, including higher BASDAI by 1.4 units (95% CI 1.0 to 1.9), ASDAS by 0.5 units (95% CI 0.3 to 0.7) and ESR by 3.5 mm/h (95% CI 0.6 to 6.4). They also had greater functional impairment with higher BASFI and BASMI by 1.2 units (95% CI 0.6 to 1.8) and 0.6 units (95% CI 0.3 to 0.8), respectively. Mean age of each study cohort inversely correlated with depression prevalence.ConclusionsDepression is common among axSpA patients and is associated with more severe disease activity and functional impairment. Identifying and managing depression should form part of their holistic care. Further longitudinal studies are needed to explore the impact of depression on treatment outcomes and axSpA treatment on symptoms of depression.

Highlights

Depression is common among patients with axial spondyloarthritis, but reports of its prevalence are highly variable
Of the 16 included studies, 14 recruited participants with ankylosing spondylitis (AS) and two reported on nr-axial spondyloarthritis (axSpA) cohorts
At least moderate depression was found in 15% of patients, estimates varied depending on the criteria and thresholds selected; pooled estimates of prevalence of depression in axSpA were 38 to 52% using lower Hospital Anxiety and Depression Scale (HADS) thresholds and the Self-Rating Depression Scale (SDS)

Summary

Introduction

Depression is common among patients with axial spondyloarthritis (axSpA), but reports of its prevalence are highly variable. Axial spondyloarthritis (axSpA) is a chronic inflammatory disease which predominantly affects the axial skeleton. It can be divided into ‘radiographic’ (ankylosing spondylitis, AS) and ‘non-radiographic’ (nr-axSpA), depending on whether definitive structural changes are evident on plain radiographs of sacroiliac joints [1, 2]. They are both characterised by inflammatory pain and functional impairment [3]. There are many different screening tools, each with variable score thresholds to define depression

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