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Prevalence of psychological disorders, sleep disturbance and stressful life events and their relationships with disease parameters in Chinese patients with ankylosing spondylitis

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Abstract

Our aim was to investigate the prevalence of psychological disorders, sleep disturbance, and stressful life events in Chinese patients with ankylosing spondylitis (AS) and healthy controls, to assess the correlation between psychological and disease-related variables, and finally to detect powerful factors in predicting anxiety and depression. AS patients diagnosed with the modified New York criteria and healthy controls were enrolled from China. Participants completed a set of questionnaires, including demographic and disease parameters, Zung self-rating anxiety scale (SAS), Zung self-rating depression scale (SDS), the Pittsburgh Sleep Quality Index questionnaire (PSQI), and the Social Readjustment Rating Scale (SRRS). The relationship between psychological and other variables was explored. Stepwise multiple regression was used to determine the contributors to each disorder. Of all the 2772 AS patients, 79.1% were male. Mean age was 28.99 ± 8.87 years. Prevalence of anxiety, depression, and sleep disturbance was 31.6% (95% CI, 29.9, to 33.4), 59.3% (95% CI, 57.5, to 61.2), and 31.0% (95% CI, 29.3, to 36.7), respectively. 35.3% had stimulus of psychological and social elements (SPSE). Compared with healthy controls, AS patients had more severe psychological disorders, sleep disturbance, and stressful life events (P < 0.01). SDS, overall pain, BASFI, and sleep disturbance were significant contributors of the SAS scores (P < 0.03). SAS, less years of education, and sleep duration were significant contributors of SDS (P < 0.01). AS patients had more anxiety, depression, stressful life events, and sleep disturbance than healthy controls. Pain, functional limitation, sleep disturbance, and education were major contributors to psychological disorders.

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References

  1. Braun J, Sieper J (2007) Ankylosing spondylitis. Lancet 369:1379–1390

    Article  PubMed  Google Scholar 

  2. Gladis MM, Gosch EA, Dishuk NM, Crits-Christoph P (1999) Quality of life: expanding the scope of clinical significance. J Consult Clin Psychol 67:320–331

    Article  CAS  PubMed  Google Scholar 

  3. McWilliams LA, Cox BJ, Enns MW (2003) Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample. Pain 106:127–133

    Article  PubMed  Google Scholar 

  4. Boonen A (2010) Towards a better understanding of the role of psychological variables in arthritis outcome research. Arthritis Res Ther 12:106

    Article  PubMed  PubMed Central  Google Scholar 

  5. Brionez TF, Assassi S, Reveille JD et al (2009) Psychological correlates of self-reported functional limitation in patients with ankylosing spondylitis. Arthritis Res Ther 11:R182

    Article  PubMed  PubMed Central  Google Scholar 

  6. Boonen A, Chorus A, Miedema H et al (2001) Withdrawal from labour force due to work disability in patients with ankylosing spondylitis. Ann Rheum Dis 60:1033–1039

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Li Y, Zhang S, Zhu J, Du X, Huang F (2012) Sleep disturbances are associated with increased pain, disease activity, depression, and anxiety in ankylosing spondylitis: a case-control study. Arthritis Res Ther 14:R215

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sayar K, Arikan M, Yontem T (2002) Sleep quality in chronic pain patients. Can J Psychiatr 47:844–848

    Article  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  10. Martindale J, Smith J, Sutton CJ, Grennan D, Goodacre L, Goodacre JA (2006) Disease and psychological status in ankylosing spondylitis. Rheumatology (Oxford) 45:1288–1293

    Article  CAS  Google Scholar 

  11. Cutolo M, Straub RH (2006) Stress as a risk factor in the pathogenesis of rheumatoid arthritis. Neuroimmunomodulation 13:277–282

    Article  CAS  PubMed  Google Scholar 

  12. Miller GE, Chen E, Zhou ES (2007) If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychol Bull 133:25–45

    Article  PubMed  Google Scholar 

  13. Ader R, Cohen N, Felten D (1995) Psychoneuroimmunology: interactions between the nervous system and the immune system. Lancet 345:99–103

    Article  CAS  PubMed  Google Scholar 

  14. Gourion D (2009) Events of life and links with severe depression at different ages. Encéphale 35(Suppl 7):S250–S256

    Article  PubMed  Google Scholar 

  15. Bolger N, Zuckerman A (1995) A framework for studying personality in the stress process. J Pers Soc Psychol 69:890–902

    Article  CAS  PubMed  Google Scholar 

  16. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the bath ankylosing spondylitis disease activity index. J Rheumatol 21:2286–2291

    CAS  PubMed  Google Scholar 

  17. Calin A, Garrett S, Het al W (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the bath ankylosing spondylitis functional index. J Rheumatol 21:2281–2285

    CAS  PubMed  Google Scholar 

  18. Zung WW (1971) A rating instrument for anxiety disorders. Psychosomatics 12:371–379

    Article  CAS  PubMed  Google Scholar 

  19. Zung WW, Richards CB, Short MJ (1965) Self-rating depression scale in an outpatient clinic. Further validation of the SDS. Arch Gen Psychiatry 13:508–515

    Article  CAS  PubMed  Google Scholar 

  20. Tsai PS, Wang SY, al WMY (2005) Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Qual Life Res 14:1943–1952

    Article  CAS  PubMed  Google Scholar 

  21. Holmes TH, Rahe RH (1967) The social readjustment rating scale. J Psychosom Res 11:213–218

    Article  CAS  PubMed  Google Scholar 

  22. Ortancil O, Konuk N, May H, Sanli A, Ozturk D, Ankarali H (2010) Psychological status and patient-assessed health instruments in ankylosing spondylitis. J Clin Rheumatol 16:313–316

    Article  PubMed  Google Scholar 

  23. Hakkou J, Rostom S, Mengat M, Aissaoui N, Bahiri R, Hajjaj-Hassouni N (2013) Sleep disturbance in Moroccan patients with ankylosing spondylitis: prevalence and relationships with disease-specific variables, psychological status and quality of life. Rheumatol Int 33:285–290

    Article  PubMed  Google Scholar 

  24. Murphy LB, Sacks JJ, Brady TJ, Hootman JM, Chapman DP (2012) Anxiety and depression among US adults with arthritis: prevalence and correlates. Arthritis Care Res (Hoboken) 64:968–976

    Google Scholar 

  25. Baysal O, Durmus B, al EY (2011) Relationship between psychological status and disease activity and quality of life in ankylosing spondylitis. Rheumatol Int 31:795–800

    Article  PubMed  Google Scholar 

  26. Dunstan DA, Scott N, Todd AK (2017) Screening for anxiety and depression: reassessing the utility of the Zung scales. BMC Psychiatry 17:329

    Article  PubMed  PubMed Central  Google Scholar 

  27. Smith BW, Zautra AJ (2008) The effects of anxiety and depression on weekly pain in women with arthritis. Pain 138:354–361

    Article  PubMed  PubMed Central  Google Scholar 

  28. Backman CL (2006) Arthritis and pain. Psychosocial aspects in the management of arthritis pain. Arthritis Res Ther 8:221

    Article  PubMed  PubMed Central  Google Scholar 

  29. Jiang Y, Yang M, Het al W (2015) The relationship between disease activity measured by the BASDAI and psychological status, stressful life events, and sleep quality in ankylosing spondylitis. Clin Rheumatol 34:503–510

    Article  PubMed  Google Scholar 

  30. Batmaz I, Sariyildiz MA, Dilek B, Bez Y, Karakoc M, Cevik R (2013) Sleep quality and associated factors in ankylosing spondylitis: relationship with disease parameters, psychological status and quality of life. Rheumatol Int 33:1039–1045

    Article  PubMed  Google Scholar 

  31. Leverment S, Clarke E, Wadeley A, Sengupta R (2017) Prevalence and factors associated with disturbed sleep in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a systematic review. Rheumatol Int 37:257–271

    Article  PubMed  Google Scholar 

  32. Evers AW, Lu Y, Duller P, van der Valk PG, Kraaimaat FW, van de Kerkhof PC (2005) Common burden of chronic skin diseases? Contributors to psychological distress in adults with psoriasis and atopic dermatitis. Br J Dermatol 152:1275–1281

  33. Zautra AJ, Hamilton NA, Potter P, Smith B (1999) Field research on the relationship between stress and disease activity in rheumatoid arthritis. Ann N Y Acad Sci 876:397–412

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Funding

This work was supported by the 5010 Subject of Sun Yat-sen University (2007023) and Guangdong Natural Science Funds for Distinguished Young Scholar (Grant No.2014A030306039).

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Authors and Affiliations

  1. Department of Rheumatology and Immunology, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China

    Yutong Jiang, Mingcan Yang, Qing Lv, Jun Qi, Zhiming Lin, Zetao Liao, Yanli Zhang, Qiujing Wei, Shuangyan Cao & Jieruo Gu

  2. Department of Rheumatology and Immunology, Beijing Jishuitan Hospital, 31 Xinjiedong Street, Beijing, China

    Husheng Wu & Hui Song

  3. Department of Rheumatology, Hainan General Hospital, 19 Xiuhua Road, Haikou, China

    Feng Zhan

  4. Department of Urology and Rheumatology, the First Affiliated Hospital of Zhengzhou University, 1 Jianshedong Road, Zhengzhou, China

    Shengyun Liu & Guanmin Gao

  5. Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, China

    Shaoxian Hu

  6. Department of Rheumatology, Fuzhou General Hospital of Nanjing Military Command, 156 Xierhuanbei Road, Fuzhou, China

    Yinong Li

  7. Department of Rheumatology and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, China

    Lingxun Shen & Anbing Huang

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  1. Yutong Jiang
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  2. Mingcan Yang
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  3. Qing Lv
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  10. Feng Zhan
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  15. Lingxun Shen
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  16. Anbing Huang
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  17. Qiujing Wei
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  18. Shuangyan Cao
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  19. Jieruo Gu
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Correspondence to Jieruo Gu.

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Jiang, Y., Yang, M., Lv, Q. et al. Prevalence of psychological disorders, sleep disturbance and stressful life events and their relationships with disease parameters in Chinese patients with ankylosing spondylitis. Clin Rheumatol 37, 407–414 (2018). https://doi.org/10.1007/s10067-017-3907-z

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  • DOI: https://doi.org/10.1007/s10067-017-3907-z

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