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HADS-depression score is a mediator for illness perception and daily life impairment in Takayasu’s arteritis

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Abstract

Introduction/objectives

The aim of this study was to evaluate the relationships among the disease activity, illness perception, daily life performance, anxiety and depression status as potential mediators in Takayasu’s arteritis (TAK) patients.

Method

In this cross-sectional study, 77 TAK patients were included. Data were collected by a clinical examination and a structured questionnaire regarding patient reported outcome measures (PROMs). Indian Takayasu’s Arteritis Activity Score2010 (ITAS2010) was used to assess the disease activity (0: inactive vs ≥ 1: active). Illness Perception Questionnaire-Revise (IPQ-R), Work Productivity and Activity Impairment (WPAI) and Hospital Anxiety and Depression Scale (HADS) as PROMs were used to understand for the patient’ perspective. After preliminary analysis, complex relationships among these variables were evaluated by mediation analyses in the study.

Results

WPAI-Daily impairment score, HADS-A and HADS-D scores as well as IPQ-R Consequence score were found be high in active TAK patients (p = 0.008; p = 0.001; p = 0.031; p = 0.001). HADS-D score was also correlated with WPAI-Daily impairment score and IPQ-R Consequence score (p < 0.05). In mediation analysis, IPQ-R Consequence score was directly mediated by disease activity (ITAS2010) (p = 0.0173) and indirectly mediated through HADS-D score (p = 0.0003). Similarly, HADS-D score was associated with poor WPAI-Daily impairment score in the mediation analysis in the indirect path (p = 0.0069). Disease activity (ITAS2010) also increased WPAI-Daily impairment score in direct path (p = 0.043).

Conclusions

Active TAK patients perceived their illness more seriously and experienced more impairment in their daily life. Depression status as the mediator influenced them poorly. These interactions could give clues to improve PROMs in the clinical practice.

Key Points

•IIness perception, disease activity, mental status and daily life performance, assessed as patient-reported outcome measures, have a complex relationship in Takayasu’s arteritis.

•IPQ-R Consequence score, WPAI-Daily impairment score, HADS-Depression and HADS-Anxiety scores were found be high in active TAK patients.

•In mediation analysis, IPQ-R Consequence score was directly mediated by disease activity and indirectly mediated through HADS-D score. Similarly, disease activity increased WPAI-Daily impairment score in direct and HADS-D in indirect paths.

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References

  1. Mason JC (2010) Takayasu arteritis—advances in diagnosis and management. Nat Rev Rheumatol 6(7):406

    Article  Google Scholar 

  2. Bicakcigil M, Aksu K, Kamali S, Ozbalkan Z, Ates A, Karadag O, Ozer H, Seyahi E, Akar S, Onen F (2009) Takayasu's arteritis in Turkey—clinical and angiographic features of 248 patients. Clin Exp Rheumatol 27(1):S59

    CAS  PubMed  Google Scholar 

  3. Yilmaz N, Can M, Oner FA, Kalfa M, Emmungil H, Karadag O, Yildiz F, Kimyon G, Yilmazer B, Gerdan V (2013) Impaired quality of life, disability and mental health in Takayasu’s arteritis. Rheumatology 52(10):1898–1904

    Article  Google Scholar 

  4. Koutantji M, Pearce S, Harrold E (2000) Psychological aspects of vasculitis. Oxford University Press, Oxford

    Book  Google Scholar 

  5. Norris SL, Glasgow RE, Engelgau MM, Os’Connor PJ, McCulloch D (2003) Chronic disease management. Disease Manag Health Outcomes 11(8):477–488

    Article  Google Scholar 

  6. Herlyn K, Hellmich B, Seo P, Merkel PA (2010) Patient-reported outcome assessment in vasculitis may provide important data and a unique perspective. Arthritis Care Res 62(11):1639–1645

    Article  Google Scholar 

  7. Mumcu G, Yağar F, Alibaz-Öner F, İnanç N, Direskeneli H, Ergun T (2019) Does illness perception associate with disease symptoms in Behçet’s disease? Intern Emerg Med 14(5):691–697

    Article  Google Scholar 

  8. Leventhal H, Brissette I, Leventhal EA (2003) The common-sense model of self-regulation of health and illness. self-reg health Ill Nehav 1:42–65

    Google Scholar 

  9. Brzoska P, Yilmaz-Aslan Y, Sultanoglu E, Sultanoglu B, Razum O (2012) The factor structure of the Turkish version of the Revised Illness Perception Questionnaire (IPQ-R) in patients with diabetes and cardiovascular disease. BMC Public Health 12(1):852

    Article  Google Scholar 

  10. Schwartz MN, Rimland CA, Quinn KA, Ferrada M, Gribbons KB, Rosenblum JS, Goodspeed W, Novakovich E, Grayson PC (2020) Utility of the brief Illness Perception Questionnaire to monitor patient beliefs in systemic vasculitis. J Rheumatol

  11. Wahlqvist P, Carlsson J, Stålhammar N-O, Wiklund I (2002) Validity of a Work Productivity and Activity Impairment questionnaire for patients with symptoms of gastro-esophageal reflux disease (WPAI-GERD)—results from a cross-sectional study. Value Health 5(2):106–113

    Article  Google Scholar 

  12. Hayes AF (2017) Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. Guilford publications, New York

    Google Scholar 

  13. Hayes AF, Rockwood NJ (2017) Regression-based statistical mediation and moderation analysis in clinical research: observations, recommendations, and implementation. Behav Res Ther 98:39–57

    Article  Google Scholar 

  14. Yay M, Çelik Z, Aksoy A, Alibaz-Öner F, Inanç N, Ergun T, Direskeneli H, Mumcu G (2019) Oral health is a mediator for disease severity in patients with Behçet’s disease: A multiple mediation analysis study. J Oral Rehabil 46(4):349–354

    PubMed  Google Scholar 

  15. Yankouskaya A, Boughey A, McCagh J, Neal A, de Bezenac C, Davies SJ (2019) Illness perception mediates the relationship between the severity of symptoms and perceived health status in patients with Behcet disease. J Clin Rheumatol 25(8):319–324

    PubMed  Google Scholar 

  16. Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, Fauci AS, Leavitt RY, Lie J, Lightfoot RW Jr (1990) The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 33(8):1129–1134

    Article  CAS  Google Scholar 

  17. Misra R, Danda D, Rajappa SM, Ghosh A, Gupta R, Mahendranath KM, Jeyaseelan L, Lawrence A, Bacon PA (2013) Development and initial validation of the Indian Takayasu clinical activity score (ITAS2010). Rheumatology 52(10):1795–1801

    Article  Google Scholar 

  18. http://ipq.h.uib.no/IPQ-R.

  19. Kocaman N, Özkan M, Armay Z, Özkan S (2007) The reliability and the validity study of Turkish adaptation of the revised Illness Perception Questionnaire. Anatolian J Psychiatry 8:271–280

    Google Scholar 

  20. Moss-Morris R, Weinman J, Petrie K, Horne R, Cameron L, Buick D (2002) The revised illness perception questionnaire (IPQ-R). Psychol Health 17(1):1–16

    Article  Google Scholar 

  21. Mumcu G, Lehimci F, Fidan Ö, Gük H, Alpar U, Ünal AU, Ertürk Z, Öner FA, Inanç GN, Ergun SAT (2017) The assessment of work productivity and activity impairment in Behcet's disease. Turk J Med Sci 47(2):535–541

  22. www.reillyassociates.net.

  23. Zhang W, Gignac MA, Beaton D, Tang K, Anis AH (2010) Productivity loss due to presenteeism among patients with arthritis: estimates from 4 instruments. J Rheumatol 37(9):1805–1814

    Article  Google Scholar 

  24. Snaith RP (2003) The hospital anxiety and depression scale. Health Qual Life Outcomes 1(1):1–4

    Article  Google Scholar 

  25. Covic T, Cumming SR, Pallant JF, Manolios N, Emery P, Conaghan PG, Tennant A (2012) Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the hospital, Anxiety and Depression Scale (HADS). BMC Psych 12(1):6

    Article  Google Scholar 

  26. Aydemir O, Guvenir T, Kuey L, Kultur S (1997) Validity and Reliability of Turkish Version of Hospital Anxiety and Depression Scale. Turk J Psychiatry 8(4):280–287

    Google Scholar 

  27. Hata A, Noda M, Moriwaki R, Numano F (1996) Angiographic findings of Takayasu arteritis: new classification. Int J Cardiol 54:S155–S163

    Article  Google Scholar 

  28. Ashley L, Smith AB, Keding A, Jones H, Velikova G, Wright P (2013) Psychometric evaluation of the revised Illness Perception Questionnaire (IPQ-R) in cancer patients: confirmatory factor analysis and Rasch analysis. J Psychosom Res 75(6):556–562

    Article  Google Scholar 

  29. Barbasio C, Vagelli R, Marengo D, Querci F, Settanni M, Tani C, Mosca M, Granieri A (2015) Illness perception in systemic lupus erythematosus patients: the roles of alexithymia and depression. Compr Psychiatry 63:88–95

    Article  Google Scholar 

  30. Grayson PC, Amudala NA, Mcalear CA, Leduc RL, Shereff D, Richesson R, Fraenkel L, Merkel PA (2013) Illness perceptions and fatigue in systemic vasculitis. Arthritis Care Res 65(11):1835–1843

    Article  Google Scholar 

  31. Searle A, Norman P, Thompson R, Vedhara K (2007) Illness representations among patients with type 2 diabetes and their partners: relationships with self-management behaviors. J Psychosom Res 63(2):175–184

    Article  Google Scholar 

  32. Bijsterbosch J, Scharloo M, Visser A, Watt I, Meulenbelt I, Huizinga T, Kaptein A, Kloppenburg M (2009) Illness perceptions in patients with osteoarthritis: change over time and association with disability. Arthritis Care Res 61(8):1054–1061

    Article  CAS  Google Scholar 

  33. Carlisle AC, John AM, Fife-Schaw C, Lloyd M (2005) The self-regulatory model in women with rheumatoid arthritis: relationships between illness representations, coping strategies, and illness outcome. Br J Health Psychol 10(4):571–587

    Article  Google Scholar 

  34. Ziarko M, Mojs E, Piasecki B, Samborski W (2014) The mediating role of dysfunctional coping in the relationship between beliefs about the disease and the level of depression in patients with rheumatoid arthritis. Sci World J 2014

  35. Murphy H, Dickens C, Creed F, Bernstein R (1999) Depression, illness perception and coping in rheumatoid arthritis. J Psychosom Res 46(2):155–164

    Article  CAS  Google Scholar 

  36. Groarke A, Curtis R, Coughlan R, Gsel A (2005) The impact of illness representations and disease activity on adjustment in women with rheumatoid arthritis: a longitudinal study. Psychol Health 20(5):597–613

    Article  Google Scholar 

  37. Lee J, Kim S-S, Jeong H-J, Son C-N, Kim J-M, Cho Y-W, Kim S-H (2017) Association of sleep quality in Behcet disease with disease activity, depression, and quality of life in Korean population. Korean J Inter Med 32(2):352

    Article  Google Scholar 

  38. Baysal Ö, Durmuş B, Ersoy Y, Altay Z, Şenel K, Nas K, Uğur M, Kaya A, Gür A, Erdal A (2011) Relationship between psychological status and disease activity and quality of life in ankylosing spondylitis. Rheumatol Int 31(6):795–800

    Article  Google Scholar 

  39. Akar S, Can G, Binicier O, Aksu K, Akinci B, Solmaz D, Birlik M, Keser G, Akkoc N, Onen F (2008) Quality of life in patients with Takayasu's arteritis is impaired and comparable with rheumatoid arthritis and ankylosing spondylitis patients. Clin Rheumatol 27(7):859–865

    Article  Google Scholar 

  40. Sreih AG, Alibaz-Oner F, Easley E, Davis T, Mumcu G, Milman N, Robson J, Direskeneli H, Merkel PA, Cronholm P (2018) Health-related outcomes of importance to patients with Takayasu’s arteritis. Clin Exp Rheumatol 36(Suppl 111):51–57

    PubMed  Google Scholar 

  41. Abularrage CJ, Slidell MB, Sidawy AN, Kreishman P, Amdur RL, Arora S (2008) Quality of life of patients with Takayasu’s arteritis. J Vasc Surg 47(1):131–137

    Article  Google Scholar 

  42. de Hooge M, Ramonda R, Lorenzin M, Frallonardo P, Punzi L, Ortolan A, Doria A (2016) Work productivity is associated with disease activity and functional ability in Italian patients with early axial spondyloarthritis: an observational study from the SPACE cohort. Arthritis Res Ther 18(1):265

    Article  Google Scholar 

  43. van Vilsteren M, Boot CR, Knol DL, van Schaardenburg D, Voskuyl AE, Steenbeek R, Anema JR (2015) Productivity at work and quality of life in patients with rheumatoid arthritis. BMC Musculoskelet Disord 16(1):107

    Article  Google Scholar 

  44. Frändemark Å, Törnblom H, Jakobsson S, Simrén M (2018) Work productivity and activity impairment in irritable bowel syndrome (IBS): a multifaceted problem. Am J Gastroenterol 113(10):1540–1549

    Article  Google Scholar 

  45. Tomelleri A, Campochiaro C, Sartorelli S, Cavalli G, De Luca G, Baldissera E, Dagna L (2019) Gender differences in clinical presentation and vascular pattern in patients with Takayasu arteritis. Scand J Rheumatol 48(6):482–490. https://doi.org/10.1080/03009742.2019.1581838

    Article  CAS  PubMed  Google Scholar 

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Author notes

  1. Simay Erdal and Banu Nalbantoğlu contributed equally to this work.

Authors and Affiliations

  1. Faculty of Medicine, Marmara University, Istanbul, Turkey

    Simay Erdal, Banu Nalbantoğlu, Mert Berke Gür, Murathan Yıldırım & Alperen Kılıçarslan

  2. Department of Internal Medicine, Division of Rheumatology, Marmara University, Istanbul, Turkey

    Sema Kaymaz-Tahra, Fatma Alibaz-Öner & Haner Direskeneli

  3. Department of Statistics, Mimar Sinan Fine Arts University, Istanbul, Turkey

    Meral Yay

  4. Faculty of Health Sciences, Marmara University, Istanbul, Turkey

    Gonca Mumcu

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Contributions

Simay Erdal, Banu Nalbantoğlu, Mert Berke Gür, Murathan Yıldırım, Alperen Kılıçarslan: Project design, data collection, statistical analysis, manuscript preparation. Sema Kaymaz-Tahra, Fatma Alibaz-Öner: Data collection, statistical analysis, manuscript preparation. Meral Yay: Data collection, statistical analysis, manuscript preparation. Gonca Mumcu: Project design, statistical analysis, manuscript preparation. Haner Direskeneli: Project design, manuscript preparation.

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Correspondence to Banu Nalbantoğlu.

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Erdal, S., Nalbantoğlu, B., Gür, M.B. et al. HADS-depression score is a mediator for illness perception and daily life impairment in Takayasu’s arteritis. Clin Rheumatol 40, 4109–4116 (2021). https://doi.org/10.1007/s10067-021-05719-2

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