Skip to main content

Advertisement

SpringerLink
Log in

Common mental disorders in South Asian patients with systemic sclerosis: a CIS-R-based cross-sectional study

  • Observational Research
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

There are not many studies looking at psychological impact of physical morbidities amongst patients with systemic sclerosis. Our aim was to describe the prevalence of common mental disorders (CMD) in systemic sclerosis patients, as against the population prevalence of CMDs. We also wanted to assess the utility of revised clinical interview schedule (CIS-R), a standardised interview technique for screening CMDs in systemic sclerosis (SSc). We prospectively recruited 93 consecutive patients fulfilling the 2013 ACR/EULAR criteria for systemic sclerosis from our single tertiary care centre. They were interviewed using CIS-R interviewing technique. These patients were assessed for the presence of psychiatric symptoms and presence of common mental disorders. Various associations of documented mental health issues and ICD-10-based psychiatric diagnosis were also analysed. A total of 29 (31%) out of 93 individuals with systemic sclerosis had a common mental disorder as per the earlier defined CIS-R cut off score of 12 and above. Fatigue (50.5%) and sleep issues (43%) were the commonest symptoms. Thirty-four patients (33.6%) fulfilled a total of 39 ICD-10 psychiatric diagnoses. Total CIS-R score is significantly associated with duration of Scleroderma in univariate analysis (p = 0.019), but there was no significant association on a multivariate analysis. Depression [18.3% as against 5% in Asian Indian general population], followed by obsessive compulsive disorder (OCD) [15.1% as against 0.7% in general population in India] were the top two ICD-10 psychiatric diagnosis in SSc. The occurrence of both depression and OCD, therefore, are far in excess compared to community prevalence. Additionally, modified CIS-R cut off of 10 instead of 12 can also improve the sensitivity (94%) of this screening interviewing tool for an ICD-10 psychiatric diagnosis. Depression is 3.4 times and OCD is 20 times commoner in our cohort of SSc than general population in India. A modified CIS-R cut-off score of 10 may further help in early recognition of these mental disorders in SSc and their referral to a psychiatrist.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Denton CP, Khanna D (2017) Systemic sclerosis. Lancet 390(10103):1685–1699. https://doi.org/10.1016/S0140-6736(17)30933-9 (ISSN 0140-6736)

    Article  PubMed  Google Scholar 

  2. Cutolo M, Soldano S, Smith V (2019) Pathophysiology of systemic sclerosis: current understanding and new insights. Expert Rev Clin Immunol 15(7):753–764. https://doi.org/10.1080/1744666X.2019.1614915

    Article  CAS  PubMed  Google Scholar 

  3. Tashkin DP, Elashoff R, Clements PJ et al (2006) Cyclophosphamide versus placebo in scleroderma lung disease. N Engl J Med 354(25):2655–2666. https://doi.org/10.1056/NEJMoa055120

    Article  CAS  PubMed  Google Scholar 

  4. Tashkin DP, Roth MD, Clements PJ et al (2016) Mycophenolate mofetil versus oral cyclophosphamide in scleroderma-related interstitial lung disease (SLS II): a randomised controlled, double-blind, parallel group trial. Lancet Respir Med 4(9):708–719. https://doi.org/10.1016/S2213-2600(16)30152-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Sircar G, Goswami RP, Sircar D, Ghosh A, Ghosh P (2018) Intravenous cyclophosphamide vs rituximab for the treatment of early diffuse scleroderma lung disease: open label, randomized, controlled trial. Rheumatology (Oxford) 57(12):2106–2113. https://doi.org/10.1093/rheumatology/key213

    Article  CAS  Google Scholar 

  6. Vachiéry JL, Galiè N, Barberá JA et al (2019) Initial combination therapy with ambrisentan + tadalafil on pulmonary arterial hypertension-related hospitalization in the AMBITION trial. J Heart Lung Transplant 38(2):194–202. https://doi.org/10.1016/j.healun.2018.11.006

    Article  PubMed  Google Scholar 

  7. Nagaraja V (2019) Management of scleroderma renal crisis. Curr Opin Rheumatol 31(3):223–230. https://doi.org/10.1097/BOR.0000000000000604

    Article  CAS  PubMed  Google Scholar 

  8. Roofeh D, Khanna D (2020) Management of systemic sclerosis: the first five years. Curr Opin Rheumatol 32(3):228–237. https://doi.org/10.1097/BOR.0000000000000711

    Article  PubMed  PubMed Central  Google Scholar 

  9. Nakayama A, Tunnicliffe DJ, Thakkar V et al (2016) Patients’ perspectives and experiences living with systemic sclerosis: a systematic review and thematic synthesis of qualitative studies. J Rheumatol 43(7):1363–1375. https://doi.org/10.3899/jrheum.151309

    Article  PubMed  Google Scholar 

  10. Cossu M, Beretta L, Mosterman P et al (2018) Unmet needs in systemic sclerosis understanding and treatment: the knowledge gaps from a scientist’s, clinician’s, and patient’s perspective. Clin Rev Allerg Immunol 55:312–331. https://doi.org/10.1007/s12016-017-8636-1

    Article  Google Scholar 

  11. van den Hoogen F, Khanna D, Fransen J et al (2013) 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum 65(11):2737–2747. https://doi.org/10.1002/art.38098

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lewis G, Pelosi AJ, Araya R, Dunn G (1992) Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychol Med 22(2):465–486. https://doi.org/10.1017/s0033291700030415

    Article  CAS  PubMed  Google Scholar 

  13. Pothen M, Kuruvilla A, Philip K, Joseph A, Jacob KS (2003) Common mental disorders among primary care attenders in Vellore, South India: nature, prevalence and risk factors. Int J Soc Psychiatry 49(2):119–125. https://doi.org/10.1177/0020764003049002005

    Article  CAS  PubMed  Google Scholar 

  14. Subramaniam K, Krishnaswamy S, Jemain AA, Hamid A, Patel V (2006) The clinical interview schedule-revised (CIS-R)-Malay version, clinical validation. Malays J Med Sci 13(1):58–62

    PubMed  PubMed Central  Google Scholar 

  15. https://www.who.int/classifications/icd/en/GRNBOOK.pdf. Accessed 17 August 2021

  16. Nunes MA, Pinheiro AP, Bessel M et al (2016) Common mental disorders and sociodemographic characteristics: baseline findings of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Braz J Psychiatry 38(2):91–97. https://doi.org/10.1590/1516-4446-2015-1714

    Article  PubMed  PubMed Central  Google Scholar 

  17. Morris A, Yelin EH, Panopalis P, Julian L, Katz PP (2011) Long-term patterns of depression and associations with health and function in a panel study of rheumatoid arthritis. J Health Psychol 16(4):667–677. https://doi.org/10.1177/1359105310386635

    Article  PubMed  PubMed Central  Google Scholar 

  18. Meszaros ZS, Perl A, Faraone SV (2012) Psychiatric symptoms in systemic lupus erythematosus: a systematic review. J Clin Psychiatry 73(7):993–1001. https://doi.org/10.4088/JCP.11r07425

    Article  PubMed  Google Scholar 

  19. Thombs BD, Taillefer SS, Hudson M, Baron M (2007) Depression in patients with systemic sclerosis: a systematic review of the evidence. Arthritis Rheum 57(6):1089–1097. https://doi.org/10.1002/art.22910

    Article  PubMed  Google Scholar 

  20. Gautham MS, Gururaj G, Varghese M et al (2020) The National Mental Health Survey of India (2016): prevalence, socio-demographic correlates and treatment gap of mental morbidity. Int J Soc Psychiatry 66(4):361–372. https://doi.org/10.1177/0020764020907941

    Article  PubMed  Google Scholar 

  21. Khan OA, Majeed R, Kamal K, Sherazi M, Saad M (2019) Anxiety, depression, and obsessive-compulsive disorder in a recently diagnosed case of systemic sclerosis. Cureus 11(5):e4748. https://doi.org/10.7759/cureus.4748

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ghasemi H, Nomani H, Sahebkar A, Mohammadpour AH (2020) Anti-inflammatory augmentation therapy in obsessive-compulsive disorder: a review. Lett Drug Des Discov 17:1198–1205

    Article  CAS  Google Scholar 

  23. Westwell-Roper C, Williams KA, Samuels J, Bienvenu OJ et al (2019) Immune-related comorbidities in childhood-onset obsessive compulsive disorder: lifetime prevalence in the obsessive compulsive disorder collaborative genetics association study. J Child Adolesc Psychopharmacol 29(8):615–624

    Article  Google Scholar 

  24. Alsheikh AM, Alsheikh MM (2021) Obsessive-compulsive disorder with rheumatological and inflammatory diseases: a systematic review. Cureus 13(5):e14791. https://doi.org/10.7759/cureus.14791

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Authors acknowledge Dr. Rajesh G and Dr. Anju Kuruvilla, Department of Psychiatry, Christian medical college, Vellore for their significant contributions and assistance in designing this study.

Funding

This study was funded by research grant from Christian medical college, Vellore. Institutional review board approved research grant number 22Y211.

Author information

Author notes

  1. Debashish Danda—Joint first author.

Authors and Affiliations

  1. Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu, India

    Avanish Jha, Debashish Danda & Sangeetha Priya

  2. Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India

    Abigail Ruth Gojer

  3. Department of Clinical Immunology and Rheumatology, Apollo Hospital, Bhubaneswar, Odisha, India

    Ajit Kumar Surin

  4. Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, Lucknow, India

    Rachana Shenoy

  5. Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India

    Bijesh Yadav

Authors
  1. Avanish Jha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Debashish Danda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abigail Ruth Gojer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ajit Kumar Surin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rachana Shenoy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sangeetha Priya
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bijesh Yadav
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Debashish Danda.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. Our study was approved by the institutional review board (IRB no. 7926-date-19.09.2012).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (XLSX 27 KB)

Supplementary file2 (DOCX 14 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jha, A., Danda, D., Gojer, A.R. et al. Common mental disorders in South Asian patients with systemic sclerosis: a CIS-R-based cross-sectional study. Rheumatol Int 42, 1383–1391 (2022). https://doi.org/10.1007/s00296-022-05096-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-022-05096-2

Keywords

Search

Navigation