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The Relationship Between Anxiety, Depression, Suicidal Ideation and Quality of Life in Patients with Rheumatoid Arthritis

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Abstract

Rheumatoid arthritis (RA) is a chronic disease and many patients with RA experience lifelong anxiety and depression. The aim of this study is to provide an assessment of anxiety, depression, suicidal ideation, disease activity and quality of life in patients with RA. Fifty patients were included in the study. Hospital Anxiety and Depression Scale (HADS), Short Form Health Survey (SF-36), Beck Scale for Suicide Ideation (BSSI) and Disease Activity Score (DAS-28) were applied. A statistically negative correlation was found between HADS-A and HADS-D scores and all subscales of SF-36. There was a statistically negative correlation between the DAS-28 score and the subscales of the SF-36 except mental health and bodily pain. Suicidal ideation was associated with anxiety and depression and BSSI scores of patients suffering from anxiety and depression are higher than the patients not suffering from anxiety and depression. There was a statistically negative correlation between BSSI and the subscales of SF-36 excepting physical role. This study indicated that anxiety, depression, quality of life, disease activity and suicidal ideation are related to each other in patients with RA. The presence of concomitant anxiety and depression may lead to suicide and poor quality of life and may worsen the prognosis of the RA.

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References

  1. Watad A, Bragazzi NL, Adawi M, et al. Anxiety disorder among rheumatoid arthritis patients: insights from real-life data. J Affect Disord. 2017;213:30–4.

    PubMed  Google Scholar 

  2. Suzuki A, Yamamoto K. From genetics to functional insights into rheumatoid arthritis. Clin Exp Rheumatol. 2015;33(4 Suppl 92):S40–3.

    PubMed  Google Scholar 

  3. Walsh NC, Crotti TN, Goldring SR, Gravallese EM. Rheumatic diseases: the effects of inflammation on bone. Immunol Rev. 2005;208:228–51.

    CAS  PubMed  Google Scholar 

  4. Nas K, Sarac AJ, Gur A, Cevik R, Altay Z, Erdal A, et al. Psychological status is associated with health related quality of life in patients with rheumatoid arthritis. J Back Musculoskelet Rehabil. 2011;24:95–100.

    PubMed  Google Scholar 

  5. Soósová MS, Macejová Ž, Zamboriová M, Dimunová L. Anxiety and depression in Slovak patients with rheumatoid arthritis. J Ment Health. 2017;26:21–7.

    PubMed  Google Scholar 

  6. Eberhardt K, Larsson BM, Nived K. Psychological reactions in patients with early rheumatoid arthritis. Patient Educ Couns. 1993;20(2–3):93–100.

    CAS  PubMed  Google Scholar 

  7. McWilliams LA, Clara IP, Murphy PDJ, Cox BJ, Sareen J. Associations between arthritis and a broad range of psychiatric disorders: findings from a nationally representative sample. J Pain. 2008;9:37–44.

    PubMed  Google Scholar 

  8. Pinho de Oliveira Ribeiro N, Rafael de Mello Schier A, Ornelas AC, Pinho de Oliveira CM, Nardi AE, Silva AC. Anxiety, depression and suicidal ideation in patients with rheumatoid arthritis in use of methotrexate, hydroxychloroquine, leflunomide and biological drugs. Compr Psychiatry. 2013;54:1185–9.

    PubMed  Google Scholar 

  9. Isik A, Koca SS, Ozturk A, Mermi O. Anxiety and depression in patients with rheumatoid arthritis. Clin Rheumatol. 2007;26:872–8.

    PubMed  Google Scholar 

  10. VanDyke MM, Parker JC, Smarr KL, Hewett JE, Johnson GE, Slaughter JR, et al. Anxiety in rheumatoid arthritis. Arthritis Rheum. 2004;51:408–12.

    PubMed  Google Scholar 

  11. Wittchen HU, Kessler RC, Pfister H, Lieb M. Why do people with anxiety disorders become depressed? A prospective-longitudinal community study. Acta Psychiatr Scand Suppl. 2000;406:14–23.

    Google Scholar 

  12. Fiest KM, Hitchon CA, Bernstein CN, Peschken CA, Walker JR, Graff LA, et al. CIHR team “defining the burden and managing the effects of psychiatric comorbidity in chronic Immunoinflammatory disease”. Systematic review and meta-analysis of interventions for depression and anxiety in persons with rheumatoid arthritis. J Clin Rheumatol. 2017;23:425–34.

    PubMed  PubMed Central  Google Scholar 

  13. Matcham F, Norton S, Scott DL, Steer S, Hotopf M. Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis: secondary analysis of a randomized controlled trial. Rheumatology (Oxford). 2016;55:268–78.

    Google Scholar 

  14. Sturgeon JA, Finan PH, Zautra AJ. Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways. Nat Rev Rheumatol. 2016;12:532–42.

    PubMed  PubMed Central  Google Scholar 

  15. Fuller-Thomson E, Shaked Y. Factors associated with depression and suicidal ideation among individuals with arthritis or rheumatism: findings from a representative community survey. Arthritis Rheum. 2009;61:944–50.

    PubMed  Google Scholar 

  16. Calandre EP, Rico-Villademoros F, Slim M. Suicidal behaviors in patients with rheumatic diseases: a narrative review. Rheumatol Int. 2018;38:537–48.

    PubMed  Google Scholar 

  17. Treharne GJ, Lyons AC, Kitas GD. Suicidal ideation in patients with rheumatoid arthritis. Research may help identify patients at high risk. BMJ. 2000;321:1290.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Ang DC, Choi H, Kroenke K, Wolfe F. Comorbid depression is an independent risk factor for mortality in patients with rheumatoid arthritis. J Rheumatol. 2005;32:1013–9.

    PubMed  Google Scholar 

  19. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.

    CAS  PubMed  Google Scholar 

  20. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83.

    PubMed  Google Scholar 

  21. Beck AT, Kovacs M, Weissman A. Assesment of suicide suicide intention: the scale for suicide ideation. J Consult Clin Psychology. 1979;47:343–52.

    CAS  Google Scholar 

  22. van der Heijde DM, van’t Hof MA, van Riel PL, et al. Judging disease activity in clinical practice in rheumatoid arthritis: first step in the development of a disease activity score. Ann Rheum Dis. 1990;49:916–20.

    PubMed  PubMed Central  Google Scholar 

  23. Zhang L, Xia Y, Zhang Q, et al. The correlations of socioeconomic status, disease activity, quality of life, and depression/anxiety in Chinese patients with rheumatoid arthritis. Psychol Health Med. 2017;22:28–36.

    PubMed  Google Scholar 

  24. Löwe B, Willand L, Eich W, Zipfel S, Ho AD, Herzog W, et al. Psychiatric comorbidity and work disability in patients with inflammatory rheumatic diseases. Psychosom Med. 2004;66:395–402.

    PubMed  Google Scholar 

  25. Ho RC, Fu EH, Chua AN, Cheak AA, Mak A. Clinical and psychosocial factors associated with depression and anxiety in Singaporean patients with rheumatoid arthritis. Int J Rheum Dis. 2011;14:37–47.

    PubMed  Google Scholar 

  26. Abdel-Nasser AM, Abd El-Azim S, Taal E, El-Badawy SA, Rasker JJ, Valkenburg HA. Depression and depressive symptoms in rheumatoid arthritis patients: an analysis of their occurrence and determinants. Br J Rheumatol. 1998;37:391–7.

    CAS  PubMed  Google Scholar 

  27. Berkanovic E, Oster P, Wong WK, Bulpitt K, Clements P, Sterz M, et al. The relationship between socioeconomic status and recently diagnosed rheumatoid arthritis. Arthritis Care Res. 1996;9:257–62.

    CAS  PubMed  Google Scholar 

  28. Reese JB, Somers TJ, Keefe FJ, Mosley-Williams A, Lumley MA. Pain and functioning of rheumatoid arthritis patients based on marital status: is a distressed marriage preferable to no marriage? J Pain. 2010;11:958–64.

    PubMed  PubMed Central  Google Scholar 

  29. Wan SW, He HG, Mak A, Lahiri M, Luo N, Cheung PP, et al. Health-related quality of life and its predictors among patients with rheumatoid arthritis. Appl Nurs Res. 2016;30:176–83.

    PubMed  Google Scholar 

  30. Barlow JH, Cullen LA, Rowe IF. Educational preferences, psychological well-being and self-efficacy among people with rheumatoid arthritis. Patient Educ Couns. 2002;46:11–9.

    CAS  PubMed  Google Scholar 

  31. Margaretten M, Yelin E, Imboden J, Graf J, Barton J, Katz P, et al. Predictors of depression in a multiethnic cohort of patients with rheumatoid arthritis. Arthritis Rheum. 2009;61:1586–91.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Gettings L. Psychological well-being in rheumatoid arthritis: a review of the literature. Musculoskeletal Care. 2010;8:99–106.

    PubMed  Google Scholar 

  33. Dickens C, Jackson J, Tomenson B, Hay E, Creed F. Association of depression and rheumatoid arthritis. Psychosomatics. 2003;44:209–15.

    PubMed  Google Scholar 

  34. Elenkov IJ. Neurohormonal-cytokine interactions: implications for inflammation, common human diseases and well-being. Neurochem Int. 2008;52:40–51.

    CAS  PubMed  Google Scholar 

  35. Kojima M, Furukawa TA, Takahashi H, Kawai M, Nagaya T, Tokudome S. Cross-cultural validation of the Beck Depression Inventory-II in Japan. Psychiatry Res. 2002;110:291–9.

    PubMed  Google Scholar 

  36. Smith BW, Zautra AJ. The effects of anxiety and depression on weekly pain in women with arthritis. Pain. 2008;138:354–61.

    PubMed  PubMed Central  Google Scholar 

  37. Katz PP, Yelin EH. Activity loss and the onset of depressive symptoms: do some activities matter more than others? Arthritis Rheum. 2001;44:1194–202.

    CAS  PubMed  Google Scholar 

  38. Krol B, Sanderman R, Suurmeijer T, Doeglas D, van Rijswijk M, van Leeuwen M. Disease characteristics, level of self-esteem and psychological well-being in rheumatoid arthritis patients. Scand J Rheumatol. 1994;23:8–12.

    CAS  PubMed  Google Scholar 

  39. Cho SK, Kim D, Jun JB, Bae SC, Sung YK. Factors influencing quality of life (QOL) for Korean patients with rheumatoid arthritis (RA). Rheumatol Int. 2013;33:93–102.

    PubMed  Google Scholar 

  40. Timonen M, Viilo K, Hakko H, Särkioja T, Ylikulju M, Meyer-Rochow VB, et al. Suicides in persons suffering from rheumatoid arthritis. Rheumatology (Oxford). 2003;42:287–91.

    CAS  Google Scholar 

  41. Fuller-Thomson E, Ramzan N, Baird SL. Arthritis and suicide attempts: findings from a large nationally representative Canadian survey. Rheumatol Int. 2016;36:1237–48.

    PubMed  Google Scholar 

  42. Shim E, Song YW, Park SH, Lee KM, Go DJ, Hahm BJ. Examining the relationship between pain catastrophizing and suicide risk in patients with rheumatic disease: the mediating role of depression, perceived social support, and perceived burdensomeness. Int J Behav Med. 2017;24:501–12.

    Google Scholar 

  43. Tektonidou MG, Dasgupta A, Ward MM. Suicidal ideation among adults with arthritis: prevalence and subgroups at highest risk. Data from the 2007-2008 National Health and Nutrition Examination Survey. Arthritis Care Res (Hoboken). 2011;63:1322–33.

    Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Halaskargazi Street, Şişli, 34371, İstanbul, Turkey

    Aslı Beşirli & Ömer Akil Özer

  2. Department of Physical Medicine and Rehabilitation, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Şişli, İstanbul, Turkey

    Jülide Öncü Alptekin

  3. Department of Psychiatry, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey

    Derya Kaymak

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  1. Aslı Beşirli
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  2. Jülide Öncü Alptekin
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  3. Derya Kaymak
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  4. Ömer Akil Özer
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Correspondence to Aslı Beşirli.

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Beşirli, A., Alptekin, J.Ö., Kaymak, D. et al. The Relationship Between Anxiety, Depression, Suicidal Ideation and Quality of Life in Patients with Rheumatoid Arthritis. Psychiatr Q 91, 53–64 (2020). https://doi.org/10.1007/s11126-019-09680-x

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  • DOI: https://doi.org/10.1007/s11126-019-09680-x

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