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The relationship between depressive symptoms, illness perceptions and quality of life in ankylosing spondylitis in comparison to rheumatoid arthritis

Clinical Rheumatology volume 32, pages 635–644 (2013)Cite this article

Abstract

Anxiety and depressive symptoms as well as cognitive variables are important in determining outcome in rheumatic diseases. We aimed to compare psychological distress symptoms and illness perceptions in ankylosing spondylitis (AS) and rheumatoid arthritis (RA) and to test whether their associations with health-related quality of life (HRQoL) were similar in these rheumatologic disorders. In 55 AS and 199 RA patients, we administered the Patient Health Questionnaire (PHQ-9), the Symptom Check-List and the Brief-Illness Perception Questionnaire to assess psychological variables and the World Health Organization Quality of Life Instrument, Short Form to assess HRQoL. We used hierarchical regression analyses to determine the associations between psychological variables and HRQoL after adjusting for demographic variables and disease parameters. The prevalence of clinically significant depressive symptoms (PHQ-9 ≥ 10) was 14.8 % in AS and 25.1 % in RA patients, but adjustment for demographics rendered these differences in depressive symptoms’ severity non-significant. Psychological distress levels and HRQoL were similar in both disorders. Illness concern (b = −0.37) was the only significant independent correlate of physical HRQoL in AS. In RA, depression (b = −0.25), illness concern (b = −0.14) and worries about the consequences of the disease (b = −0.31) were the independent correlates of physical HRQoL. These findings suggest that cognitive variables are important correlates of HRQoL in AS, whereas in RA depressive symptoms and illness perceptions equally contribute to HRQoL. Our data encourage the design of psychotherapeutic trials targeting disease-related cognitions in AS in an attempt to improve patient’s physical HRQoL.

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References

  1. Klippel JH, Stone JH, Crofford LJ, White PH (eds) (2008) Primer on the rheumatic diseases, 13th edn. Springer, New York

  2. Alamanos Y, Papadopoulos NG, Voulgari PV et al (2004) Epidemiology of ankylosing spondylitis in Northwest Greece, 1983–2002. Rheumatology (Oxford) 43(5):615–618

    Article  CAS  Google Scholar 

  3. Boonen A, Chorus A, Miedema H et al (2001) Employment, work disability, and work days lost in patients with ankylosing spondylitis: a cross sectional study of Dutch patients. Ann Rheum Dis 60:353–358

    PubMed  Article  CAS  Google Scholar 

  4. Boonen A, van der Heijde D, Landewé R et al (2003) Direct costs of ankylosing spondylitis and its determinants: an analysis among three European countries. Ann Rheum Dis 62:732–740

    PubMed  Article  CAS  Google Scholar 

  5. Salaffi F, Carotti M, Gasparini S, Intorcia M, Grassi W (2009) The health-related quality of life in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis: a comparison with a selected sample of healthy people. Health Qual Life Outcomes 7:25

    PubMed  Article  Google Scholar 

  6. Dagfinrud H, Mengshoel AM, Hagen KB, Loge JH, Kvien TK (2004) Health status of patients with ankylosing spondylitis: a comparison with the general population. Ann Rheum Dis 63(12):1605–1610

    PubMed  Article  CAS  Google Scholar 

  7. Hudson M, Thombs BD, Steele R, Panopalis P, Newton E, Baron M, Canadian Scleroderma Research Group (2009) Health-related quality of life in systemic sclerosis: a systematic review. Arthritis Rheum 61:1112–1120

    PubMed  Article  Google Scholar 

  8. Murphy H, Dickens C, Creed F, Bernstein R (1999) Depression, illness perception and coping in rheumatoid arthritis. J Psychosom Res 46:155–164

    PubMed  Article  CAS  Google Scholar 

  9. Baubet T, Ranque B, Taieb O et al (2011) Mood and anxiety disorders in systemic sclerosis patients. Presse Med 40:e111–119

    PubMed  Article  Google Scholar 

  10. Bachen EA, Chesney MA, Criswell LA (2009) Prevalence of mood and anxiety disorders in women with systemic lupus erythematosus. Arthritis Rheum 61(6):822–829

    PubMed  Article  Google Scholar 

  11. Günaydin R, Göksel Karatepe A, Ceşmeli N, Kaya T (2009) Fatigue in patients with ankylosing spondylitis: relationships with disease-specific variables, depression, and sleep disturbance. Clin Rheumatol 28(9):1045–1051

    PubMed  Article  Google Scholar 

  12. Zung WWK (1965) A self-rating depression scale. Arch Gen Psychiatry 12:63–70

    PubMed  Article  CAS  Google Scholar 

  13. Barlow JH, Macey SJ, Struthers GR (1993) Gender, depression, and ankylosing spondylitis. Arthritis Care Res 6:45–51

    PubMed  Article  CAS  Google Scholar 

  14. Ward MM (1999) Health-related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis Care Res 12:247–255

    PubMed  Article  CAS  Google Scholar 

  15. Bakker C, van der Linden S, van Santen-Hoeufft M, Bolwijn P, Hidding A (1995) Problem elicitation to assess patient priorities in ankylosing spondylitis and fibromyalgia. J Rheumatol 22:1304–1310

    PubMed  CAS  Google Scholar 

  16. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Press, Washington, DC

    Google Scholar 

  17. Kroenke KS, Robert L (2002) The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann 32:509–515

    Google Scholar 

  18. Hyphantis T, Kotsis K, Voulgari PV, Tsifetaki N, Creed F, Drosos AA (2011) Diagnostic accuracy, internal consistency and convergent validity of the Greek version of PHQ-9 in diagnosing depression in rheumatological disorders. Arthritis Care Res (Hoboken) 63:1313–1321

    Article  Google Scholar 

  19. Leventhal H, Nerenz DR, Steele DJ (1984) Illness representation and coping with health threats. In: Baum A, Taylor SE, Singer JE (eds) The handbook of psychology and health. Vol IV: social psychological aspects of health. Erlbaum, Hillsdale, pp 219–252

    Google Scholar 

  20. Richards HL, Herrick AL, Griffin K, Gwilliam PD, Loukes J, Fortune DG (2003) Systemic sclerosis: patients' perceptions of their condition. Arthritis Rheum 49:689–696

    PubMed  Article  Google Scholar 

  21. Kotsis K, Voulgari PV, Tsifetaki N et al (2012) Anxiety and depressive symptoms and illness perceptions in psoriatic arthritis and associations with physical health-related quality of life. Arthritis Care Res (Hoboken) 64(10):1593–601

    Article  Google Scholar 

  22. Van der Linden SM, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum 27:361–368

    PubMed  Article  Google Scholar 

  23. Chorus AM, Miedema HS, Boonen A, Van Der Linden S (2003) Quality of life and work in patients with rheumatoid arthritis and ankylosing spondylitis of working age. Ann Rheum Dis 62(12):1178–1184

    PubMed  Article  CAS  Google Scholar 

  24. Zink A, Braun J, Listing J, Wollenhaupt J (2000) Disability and handicap in rheumatoid arthritis and ankylosing spondylitis—results from the German rheumatological database. German Collaborative Arthritis Centers. J Rheumatol 27:613–622

    PubMed  CAS  Google Scholar 

  25. Arnett FC, Edworthy SM, Bloch DA et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–24

    PubMed  Article  CAS  Google Scholar 

  26. Garrett S, Jenkinson T, Kennedy LG et al (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). J Rheumatol 21:2286–2291

    PubMed  CAS  Google Scholar 

  27. Prevoo ML, van’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL (1995) Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38:44–48

    PubMed  Article  CAS  Google Scholar 

  28. Derogatis LR (1994) SCL-90-R: administration, scoring, and procedure manual, 3rd edn. National Computer Systems, Minneapolis

    Google Scholar 

  29. Demyttenaere K, Desaiah D, Petit C, Croenlein J, Brecht S (2012) Time course of improvement of different symptom clusters in patients with major depression and pain treated with duloxetine or placebo. Curr Med Res Opin 28(1):41–48

    PubMed  Article  CAS  Google Scholar 

  30. Parker JC, Buckelew SP, Smarr KL, Buescher KL, Beck NC, Frank RG et al (1990) Psychological screening in rheumatoid arthritis. J Rheumatol 17:1016–1021

    PubMed  CAS  Google Scholar 

  31. Donias S, Karastergiou A, Manos N (1991) Standardization of the symptom checklist-90-R rating scale in a Greek population. Psychiatrike 2:42–48 (in Greek with English abstract)

    Google Scholar 

  32. Broadbent E, Petrie KJ, Main J, Weinman J (2006) The Brief Illness Perception Questionnaire. J Psychosom Res 60:631–637

    PubMed  Article  Google Scholar 

  33. Sluiter JK, Frings-Dresen MH (2008) Quality of life and illness perception in working and sick-listed chronic RSI patients. Int Arch Occup Environ Health 81(4):495–501

    PubMed  Article  Google Scholar 

  34. Skevington SM, Lotfy M, O'Connell KA, WHOQOL Group (2004) The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res 13(2):299–310

    PubMed  Article  CAS  Google Scholar 

  35. Power M, Harper A, Bullinger M (1999) The World Health Organization WHOQOL-100: tests of the universality of quality of life in 15 different cultural groups worldwide. Health Psychol 18:495–505

    PubMed  Article  CAS  Google Scholar 

  36. Taylor WJ, Myers J, Simpson RT, McPherson KM, Weatherall M (2004) Quality of life of people with rheumatoid arthritis as measured by the World Health Organization Quality of Life Instrument, short form (WHOQOL-BREF): score distributions and psychometric properties. Arthritis Rheum 51:350–357

    PubMed  Article  Google Scholar 

  37. Moullec G, Ninot G (2010) An integrated programme after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: effect on emotional and functional dimensions of quality of life. Clin Rehabil 24(2):122–136

    PubMed  Article  CAS  Google Scholar 

  38. Ginieri-Coccossis M, Triantafillou E, Tomaras V, Soldatos C, Mavreas V, Christodoulou G (2012) Psychometric properties of WHOQOL-BREF in clinical and health Greek populations: incorporating new culture-relevant items. Psychiatrike 23:130–142

    PubMed  CAS  Google Scholar 

  39. Aigner M, Forster-Streffleur S, Prause W, Freidl M, Weiss M, Bach M (2006) What does the WHOQOL-Bref measure? Measurement overlap between quality of life and depressive symptomatology in chronic somatoform pain disorder. Soc Psychiatry Psychiatr Epidemiol 41(1):81–86

    PubMed  Article  Google Scholar 

  40. Bai M, Tomenson B, Creed F et al (2009) The role of psychological distress and personality variables in the disablement process in rheumatoid arthritis. Scand J Rheumatol 38:419–430

    PubMed  Article  CAS  Google Scholar 

  41. Miles J, Shevlin M (2003) Applying regression and correlation. Sage, London, pp 126–132

    Google Scholar 

  42. Baysal O, Durmuş B, Ersoy Y et al (2011) Relationship between psychological status and disease activity and quality of life in ankylosing spondylitis. Rheumatol Int 31(6):795–800

    PubMed  Article  Google Scholar 

  43. Hakkou J, Rostom S, Aissaoui N et al (2011) Psychological status in Moroccan patients with ankylosing spondylitis and its relationships with disease parameters and quality of life. J Clin Rheumatol 17(8):424–8

    PubMed  Article  Google Scholar 

  44. Zigmond AS, Snaith PR (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    PubMed  Article  CAS  Google Scholar 

  45. Bijsterbosch J, Scharloo M, Visser AW et al (2009) Illness perceptions in patients with osteoarthritis: change over time and association with disability. Arthritis Rheum 61(8):1054–1061

    PubMed  Article  CAS  Google Scholar 

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Author information

Affiliations

  1. Department of Psychiatry, Medical School, University of Ioannina, Ioannina, 45110, Greece

    Thomas Hyphantis & Konstantinos Kotsis

  2. Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece

    Niki Tsifetaki, Alexandros A. Drosos & Paraskevi V. Voulgari

  3. Psychiatry Research Group, Medical School, University of Manchester, Manchester, UK

    Francis Creed

  4. Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil

    André F. Carvalho

Authors
  1. Thomas Hyphantis
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  2. Konstantinos Kotsis
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  3. Niki Tsifetaki
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  4. Francis Creed
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  5. Alexandros A. Drosos
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  6. André F. Carvalho
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  7. Paraskevi V. Voulgari
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Correspondence to Thomas Hyphantis.

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Hyphantis, T., Kotsis, K., Tsifetaki, N. et al. The relationship between depressive symptoms, illness perceptions and quality of life in ankylosing spondylitis in comparison to rheumatoid arthritis. Clin Rheumatol 32, 635–644 (2013). https://doi.org/10.1007/s10067-012-2162-6

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  • DOI: https://doi.org/10.1007/s10067-012-2162-6

Keywords

  • Ankylosing spondylitis
  • Anxiety
  • Depression
  • Illness representations
  • Quality of life