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Anxiety and depression among patients with familial Mediterranean fever

Angst und Depression bei Patienten mit familiärem Mittelmeerfieber

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Abstract

Background

Familial Mediterranean fever (FMF) is a systemic autoinflammatory disease that requires lifelong treatment and is associated with several comorbidities, including mental health disorders such as anxiety and depression. FMF and mental health necessitate further research; hence, this study aims to observe anxiety and depression and their relationship with several variables in patients with FMF.

Methods

As the study population, 360 FMF patients were surveyed between June and October 2022. Surveys included inventories assessing anxiety and depression, i.e., the Beck’s Depression Inventory (BDI), the Beck’s Anxiety Inventory (BAI), and the State-Trait Anxiety Inventory (STAI).

Results

Mean scores for STAI-Y1 (state), STAI-Y2 (trait), BAI, and BDI were 42.2 ± 12.0, 45.9 ± 10.6, 24.0 ± 13.9, and 13.1 ± 8.99, respectively. Medication-adherent patients had significantly lower scores on STAI-Y1 (41.5 ± 11.4 vs. 45.2 ± 14.0; p-value: 0.04). M694V homozygous patients exhibited significantly lower scores in the BDI (12.4 ± 9.37 vs. 13.2 ± 8.93; p-value: < 0.001) and BAI (17.0 ± 12.1 vs. 25.1 ± 13.9; p-value: 0.001). The patients with an exon-10 mutation demonstrated significantly lower scores compared to patients with an exon‑2 mutation (17.9 ± 12.3, 29.6 ± 13.3; p-value: < 0.001).

Conclusion

The patients with FMF had mild depression and moderate anxiety scores. A higher level of education and medication adherence were associated with lower levels of anxiety. Likewise, the patients with genotypes associated with severe disease courses had lower levels of anxiety. We suggest that physicians should be more attentive to patients with a milder disease course and ensure that these patients are provided with sufficient treatment and knowledge about their disease.

Zusammenfassung

Hintergrund

Das familiäre Mittelmeerfieber (FMF) ist eine systemische autoinflammatorische Erkrankung, die lebenslang behandelt werden muss und mit verschiedenen Begleiterkrankungen einhergeht, einschließlich psychischer Erkrankungen wie Angst und Depression. FMF und psychische Gesundheit erfordern weitere Untersuchungen, daher ist es das Ziel der vorliegenden Studie, den Zusammenhang von Angst und Depression mit verschiedenen Variablen bei Patienten mit FMF zu ermitteln.

Methoden

Als Studienpopulation wurden 360 FMF-Patienten zwischen Juni und Oktober 2022 erfasst. Zu den erhobenen Daten gehörten Inventare zu Bestimmung von Angst und Depression, d. h., das Beck-Depressions-Inventar (BDI), Beck-Angst-Inventar (BAI) und State-Trait-Angst-Inventar (STAI).

Ergebnisse

Die durchschnittlichen Werte für STAI-Y1 (Zustand), STAI-Y2 (Eigenschaft), BAI und BDI betrugen 42,2 ± 12,0; 45,9 ± 10,6; 24,0 ± 13,9 bzw. 13,1 ± 8,99. Patienten, die ihre Medikamente wie verordnet einnahmen, wiesen signifikant niedrigere Werte im STAI-Y1 auf (41,5 ± 11,4 vs. 45,2 ± 14,0; p-Wert: 0,04). M694V-homozygote Patienten zeigten signifikant niedrigere Werte im BDI (12,4 ± 9,37 vs. 13,2 ± 8,93; p-Wert: < 0,001) und BAI (17,0 ± 12,1 vs. 25,1 ± 13,9; p-Wert: 0,001). Bei den Patienten mit einer Exon-10-Mutation bestanden signifikant niedrigere Werte gegenüber den Patienten mit einer Exon-2-Mutation (17,9 ± 12,3; 29,6 ± 13,3; p-Wert: < 0,001).

Schlussfolgerung

Bei den Patienten mit FMF waren geringe Depressions- und mittelgradige Angstwerte festzustellen. Ein höher Bildungsgrad und die regelmäßige Medikamenteneinnahme gingen mit niedrigerer Werten für Angst einher. Gleichermaßen wiesen die Patienten mit Genotypen, die mit schweren Krankheitsverläufen einhergingen, niedriger Werte für Angst auf. Den Autoren zufolge sollten Ärzte besonders aufmerksam bei Patienten mit einem leichteren Krankheitsverlauf sein und sicherstellen, dass diese Patienten ausreichend behandelt und über ihre Krankheit informiert werden.

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References

  1. Shohat M, Halpern GJ (2011) Familial Mediterranean fever—A review. Genet Med 13(6):487–498

    Article  PubMed  Google Scholar 

  2. Yasar Bilge S, Solmaz D, Senel S, Emmungil H, Kilic L, Yilmaz Oner S et al (2019) Exon 2: Is it the good police in familial mediterranean fever? Eur J Rheumatol 6(1):33–36

    Article  Google Scholar 

  3. Grossman C, Kassel Y, Livneh A, Ben-Zvi I (2019) Familial Mediterranean fever (FMF) phenotype in patients homozygous to the MEFV M694V mutation. Eur J Med Genet 62(6):103532

    Article  PubMed  Google Scholar 

  4. Ozdogan H, Ugurlu S (2019) Familial Mediterranean Fever. Presse Med 48(1):e61–76

    Article  PubMed  Google Scholar 

  5. Grandemange S, Aksentijevich I, Jeru I, Gul A, Touitou I (2011) The regulation of MEFV expression and its role in health and familial Mediterranean fever. Genes Immun 12(7):497–503

    Article  CAS  PubMed  Google Scholar 

  6. Vallerand IA, Patten SB, Barnabe C (2019) Depression and the risk of rheumatoid arthritis. Curr Opin Rheumatol 31(3):279–284

    Article  PubMed  PubMed Central  Google Scholar 

  7. Tisseverasinghe A, Peschken C, Hitchon C (2018) Anxiety and mood disorders in systemic lupus erythematosus: current insights and future directions. Curr Rheumatol Rep 20(12):85

    Article  PubMed  Google Scholar 

  8. Lin S, Zhang H, Ma A (2018) Association of gout and depression: A systematic review and meta-analysis. Int J Geriatr Psychiatry 33(3):441–448

    Article  PubMed  Google Scholar 

  9. Sönmez AÖ, Sönmez HE, Çakan M, Yavuz M, Keskindemirci G, Aktay AN (2020) The evaluation of anxiety, depression and quality of life scores of children and adolescents with familial Mediterranean fever. Rheumatol Int 40(5):757–763

    Article  PubMed  Google Scholar 

  10. Bodur H, Gül Yurdakul F, Duruöz MT, Çay HF, Uçar Ü, Keskin Y et al (2021) Familial Mediterranean fever: health-related quality of life and associated variables in a national cohort. Arch Rheumatol 36(2):159–166

    Article  PubMed  Google Scholar 

  11. Durcan G, Yildiz M, Kadak MT, Barut K, Kavruk Erdim N, Sahin S et al (2020) Increased frequency of sleep problems in children and adolescents with familial Mediterranean fever: the role of anxiety and depression. Int J Rheum Dis 23(10):1396–1403

    Article  CAS  PubMed  Google Scholar 

  12. Giese A, Örnek A, Kilic L, Kurucay M, Şendur SN, Lainka E et al (2017) Anxiety and depression in adult patients with familial Mediterranean fever: a study comparing patients living in Germany and Turkey. Int J Rheum Dis 20(12):2093–2100

    Article  PubMed  Google Scholar 

  13. Livneh A, Langevitz P, Zemer D, Zaks N, Kees S, Lidar T et al (1997) Criteria for the diagnosis of familial mediterranean fever. Arthritis Rheum 40(10):1879–1885

    Article  CAS  PubMed  Google Scholar 

  14. Beck AT (1961) An Inventory for Measuring Depression. Arch Gen Psychiatry 4(6):561

    Article  CAS  PubMed  Google Scholar 

  15. Hisli N (1989) A reliability and validity study of beck depression inventory in a university student sample. J Psychol 7:3–13

    Google Scholar 

  16. Beck AT, Epstein N, Brown G, Steer RA (1988) An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 56(6):893–897

    Article  CAS  PubMed  Google Scholar 

  17. Ulusoy M, Sahin NH, Erkmen H (1998) Turkish version of the beck anxiety inventory. J Cogn Psychother 12:163–172

    Google Scholar 

  18. Spielberger CDGR, Lushene R, Vagg PR, Jacobs GA (1983) Manual for the state-trait anxiety inventory. Consulting Psychologists Press, Palo Alto

    Google Scholar 

  19. Oner N, LeCompte A (1998) State/Trait Anxiety Inventory, 2nd edn. Bogazici University Publ, pp 2–26

    Google Scholar 

  20. Sella AC, Hadaway N, Stern C, Becker KR, Holsen LM, Eddy KT, Micali N, Misra M, Thomas JJ, Lawson EA (2023) Lower Ghrelin levels are associated with higher anxiety symptoms in adolescents and young adults with avoidant/restrictive food intake disorder. J Clin Psychiatry 84(3)

  21. Blaesing L, Kroener-Herwig B (2012) Self-reported and behavioral sound avoidance in tinnitus and hyperacusis subjects, and association with anxiety ratings. Int J Audiol 51(8):611–617

    Article  PubMed  Google Scholar 

  22. Liu AA, Boxhorn CE, Klufas MA, Christos PJ, Thorne JT, Shih AY, Tsankova NM, Dorfman BJ, Henchcliffe C, Piboolnurak P, Nirenberg MJ (2011) Clinical predictors of frequent patient telephone calls in Parkinson’s disease. Park Relat Disord 17(2):95–99

    Article  CAS  Google Scholar 

  23. Bekker MHJ, van Mens-Verhulst J (2007) Anxiety Disorders: Sex Differences in Prevalence, Degree, and Background, But Gender-Neutral Treatment. Gend Med 4:S178–93

    Article  PubMed  Google Scholar 

  24. Bangasser DA, Cuarenta A (2021) Sex differences in anxiety and depression: circuits and mechanisms. Nat Rev Neurosci 22(11):674–684

    Article  CAS  PubMed  Google Scholar 

  25. Makay B, Emiroğlu N, Ünsal E (2010) Depression and anxiety in children and adolescents with familial Mediterranean fever. Clin Rheumatol 29(4):375–379

    Article  PubMed  Google Scholar 

  26. Slobodnick A, Shah B, Krasnokutsky S, Pillinger MH (2018) Update on colchicine, 2017. Rheumatology 57(suppl_1):i4–11

    Article  CAS  PubMed  Google Scholar 

  27. Özen S, Sag E, Ben-Chetrit E, Gattorno M, Gül A, Hashkes PJ et al (2021) Defining colchicine resistance/intolerance in patients with familial Mediterranean fever: a modified-Delphi consensus approach. Rheumatology 60(8):3799–3808

    Article  PubMed  Google Scholar 

  28. Tekgöz E, Çolak S, Çınar Fİ, Yılmaz S, Çınar M (2021) Non-adherence to colchicine treatment is a common misevaluation in familial Mediterranean fever. Turk J Med Sci 51(5):2357–2363

    Article  PubMed  Google Scholar 

  29. Di Novi C, Leporatti L, Montefiori M (2021) The role of education in psychological response to adverse health shocks. Health Policy (new york) 125(5):643–650

    Article  Google Scholar 

  30. Bjelland I, Krokstad S, Mykletun A, Dahl AA, Tell GS, Tambs K (2008) Does a higher educational level protect against anxiety and depression? The HUNT study. Soc Sci Med 66(6):1334–1345

    Article  PubMed  Google Scholar 

  31. Touitou I (2001) The spectrum of Familial Mediterranean Fever (FMF) mutations. Eur J Hum Genet 9(7):473–483

    Article  CAS  PubMed  Google Scholar 

  32. Akpolat T, Özkaya O, Özen S (2012) Homozygous M694V as a risk factor for amyloidosis in Turkish FMF patients. Gene 492(1):285–289

    Article  CAS  PubMed  Google Scholar 

  33. Kelesoglu FM, Aygun E, Okumus NK, Ersoy A, Karapınar E, Saglam N et al (2016) Evaluation of subclinical inflammation in familial Mediterranean fever patients: relations with mutation types and attack status: a retrospective study. Clin Rheumatol 35(11):2757–2763

    Article  PubMed  Google Scholar 

  34. Milaneschi Y, Kappelmann N, Ye Z, Lamers F, Moser S, Jones PB et al (2021) Association of inflammation with depression and anxiety: evidence for symptom-specificity and potential causality from UK Biobank and NESDA cohorts. Mol Psychiatry 26(12):7393–7402

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Wong ML, Inserra A, Lewis MD, Mastronardi CA, Leong L, Choo J et al (2016) Inflammasome signaling affects anxiety- and depressive-like behavior and gut microbiome composition. Mol Psychiatry 21(6):797–805

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Zainal NH, Newman MG (2022) Inflammation mediates depression and generalized anxiety symptoms predicting executive function impairment after 18 years. J Affect Disord 296:465–475

    Article  PubMed  Google Scholar 

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Acknowledgements

Ozgur Can Kilinc, Abdulmenaf Kilinc, and Selim Ardac contributed to data collection. Statistical analysis of the collected data was performed by Feyza Nur Azman. Serdal Ugurlu, Omer Faruk Demirel, Ozgur Can Kilinc, and Bugra Egeli contributed to design of the study and writing of the manuscript.

Funding

No specific funding was received from any bodies in the public, commercial, or not-for-profit sectors to carry out the work described in this article.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University—Cerrahpasa, 53 Kocamustafapasa Street, Fatih, 34098, Istanbul, Turkey

    Ozgur C. Kilinc, Abdulmenaf Kilinc, Feyza N. Azman, Selim Ardac &  Serdal Ugurlu

  2. Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, USA

    Bugra Egeli

  3. Department of Psychiatry, Istanbul University—Cerrahpasa, Istanbul, Turkey

    Omer F. Demirel

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  1. Ozgur C. Kilinc
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  2. Abdulmenaf Kilinc
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Corresponding author

Correspondence to Serdal Ugurlu.

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Conflict of interest

O.C. Kilinc, A. Kilinc, F.N. Azman, S. Ardac, B. Egeli, O.F. Demirel, and S. Ugurlu declare that they have no competing interests.

The study was compliant with the 1975 Helsinki Declaration and was approved by the Ethics Committee of Istanbul University-Cerrahpasa. Prior to participation, written informed consent was obtained from each patient.

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Ulf Müller-Ladner, Bad Nauheim

Uwe Lange, Bad Nauheim

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Data Availability

The data that support the findings of this study are available within the article and supplementary materials. Raw data of this study are available upon request from the authors. Due to confidentiality and privacy restrictions, the data cannot be publicly shared. Requests for data access should be directed to Ozgur Can Kilinc at ozgurcanklnc@gmail.com.

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Kilinc, O.C., Kilinc, A., Azman, F.N. et al. Anxiety and depression among patients with familial Mediterranean fever. Z Rheumatol 83 (Suppl 1), 236–241 (2024). https://doi.org/10.1007/s00393-023-01445-z

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