Prognostic factors for change in self-reported anxiety and depression in spondyloarthritis patients: data from the population-based SpAScania cohort from southern Sweden

Figures & data

Table 1. Sociodemographics and patient-reported outcome measures (PROMs) for the spondyloarthritis patients in the 2009 and 2011 cohorts (n = 1629).

	2009	2011	p
Sociodemographics
Age (years)	55.8 ± 13.1	–	–
Female gender	858 (53)	–	–
Disease duration (years)	14.6 ± 11.7	–	–
Level of education			–
Elementary school	253 (16)	–
Apprenticeship	312 (19)	–
High school	471 (29)	–
College/university	582 (36)	–
Marital status (single)	339 (21)	366 (26)	0.012†
Living status, living alone	321 (20)	346 (22)	0.007†
Employed or self-employed	912 (57)	733 (46)	< 0.001†
PROMs and disease characteristics
Chronic pain			< 0.001‡
No chronic pain syndrome	418 (27)	420 (27)
Regional chronic pain syndrome	337 (22)	332 (22)
Chronic widespread pain syndrome	787 (51)	788 (51)
NRS fatigue (0–10)	4.62 ± 2.73	4.93 ± 2.74	< 0.001§
NRS general health (0–10)	4.01 ± 2.30	4.27 ± 2.41	< 0.001§
EQ-5D	0.66 ± 0.24	0.66 ± 0.25	0.259§
BASDAI	4.3 ± 2.2	3.96 ± 2.24	0.563§
BASFI	3.1 ± 2.5	3.34 ± 2.59	0.000§
ASES–Pain	50.6 ± 21.4	50.0 ± 21.1	0.284§
ASES–Symptom	58.1 ± 21.1	57.7 ± 20.6	0.463§
HADS-A	5.75 ± 4.21	5.58 ± 4.38	0.099§
HADS-A, possible/probable case	498 (31)	411 (25)	< 0.001†
HADS-D	4.22 ± 3.49	4.24 ± 3.61	0.417§
HADS-D, possible/probable case	207 (13)	218 (14)	0.41†
HADS-A and D possible case	171 (11)	162 (10)	0.51†

Data are shown as mean ± SD or n (%).

NRS, numeric rating scale; EQ-5D, EuroQol 5 Dimensions; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BASFI, Bath Ankylosing Spondylitis Functional Index; ASES, Arthritis Self-Efficacy Scale; HADS, Hospital Anxiety and Depression Scale; HADS-A, HADS-Anxiety; HADS-D, HADS-Depression.

§Paired t test; †McNemar test; ‡chi-squared test.

Figure 1. Self-reported anxiety: transitions between the three Hospital Anxiety and Depression Scale subscale Anxiety (HADS-A) classes (class I: 0–8 ‘no case’; class II: 8–11 ‘possible case’; and class III: 11–21 ‘probable case’ of anxiety) over a 2 year follow-up period of all patients in the SpAScania cohort who responded to both the 2009 and 2011 questionnaires and had a valid HADS-A score at both time-points (n = 1586).

Figure 2. Self-reported depression: transitions between the three Hospital Anxiety and Depression Scale subscale Depression (HADS-D) classes (class I: 0–8 ‘no case’; class II: 8–11 ‘possible case’; and class III: 11–21 ‘probable case’ of depression) over a 2 year follow-up period of all patients in the SpAScania cohort who responded to both the 2009 and 2011 questionnaires and had a valid HADS-D score at both time-points (n = 1589).

Table 2. Logistic regression analysis of stable disease vs improving to non-disease based on the Hospital Anxiety and Depression Scale (HADS) as the dependent variable and all independent variables entered separately in the model.

	Improved HADS-A		Improved HADS-D
Univariate logistic regression analysis	Crude OR	95% CI	Crude OR	95% CI
Age (years)	0.986	0.986, 1.005	1.003	0.970, 1.038
Disease duration (years)	1.003	0.980, 1.026	0.993	0.950, 1.038
Being employed/self-employed	1.618	0.988, 2.652	3.714*	1.271, 10.86
Being female	1.171	0.718, 1.911	1.426	0.599, 3.391
Educational level (1–4, low–high)
Level 1 Elementary school	–	–	–	–
Level 2 Apprenticeship	0.680	0.316, 1.463	0.402	0.088, 1.825
Level 3 High school	1.200	0.544, 2.645	0.589	0.133, 2.606
Level 4 College/university	0.871	0.434, 1.746	0.830	0.191, 3.609
Diagnostic subtype
AS	–	–	–	–
PsA	0.848	0.481, 1.497	0.980	0.333, 2.886
U-SpA	1.091	0.537, 2.217	0.557	0.153, 2.034
Pain group
No chronic pain	–	–	–	–
Chronic regional pain	0.775	0.279, 2.150	1.182	0.197, 7.082
Chronic widespread pain	0.380*	0.173, 0.834	0.688	0.174, 2.717
Fatigue (NRS 0–10, best–worst)	0.733*	0.648, 0.830	0.620*	0.459, 0.838
General health (NRS 0–10, best–worst)	0.722*	0.636, 0.820	0.745*	0.593, 0.936
EQ-5D score (−0.549 to 1, 1 = full health)	10.86*	4.546, 25.92	12.73*	2.905, 55.77
BASFI (0–10, best–worst)	0.791*	0.715, 0.875	0.796*	0.661, 0.959
BASDAI (0–10, best–worst)	0.749*	0.647, 0.867	0.718*	0.529, 0.974
ASES Pain (10–100, worst–best)	1.033*	1.017, 1.049	1.041*	1.006, 1.077
ASES Symptom (10–100, worst–best)	1.054*	1.035, 1.074	1.093*	1.046, 1.143
HADS other (0–21, best–worst)	0.755*	0.694, 0.822	0.855*	0.757, 0.966

HADS-Anxiety (HADS-A): 1181 stable vs 248 improved patients; HADS-Depression (HADS-D): 1402 vs 118 improved patients.

AS, ankylosing spondylitis; PsA, psoriatic arthritis; U-SpA, undifferentiated spondyloarthritis; NRS, numeric rating scale; EQ-5D, EuroQol 5 Dimensions; BASFI, Bath Ankylosing Spondylitis Functional Index; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; ASES, arthritis self-efficacy scale; OR, odds ratio; CI, confidence interval.

*Significant (p < 0.05) odds ratio.

Table 3. Logistic regression analysis of stable non-disease vs deteriorating to possible or probable disease based on the Hospital Anxiety and Depression Scale (HADS) as the dependent variable and all independent variables entered separately in the model.

	Deteriorated HADS-A		Deteriorated HADS-D
Univariate logistic regression analysis	Crude OR	95% CI	Crude OR	95% CI
Age (years)	0.990	0.975, 1.005	1.003	0.987, 1.020
Disease duration (years)	0.981	0.960, 1.002	1.002	0.982, 1.022
Being employed/self-employed	1.110	0.733, 1.682	0.819	0.537, 1.250
Being female	1.428	0.957, 2.131	0.931	0.613, 1.416
Educational level (1–4, low–high)
Level 1 Elementary school	–	–	–	–
Level 2 Apprenticeship	1.018	0.471, 2.204	0.833	0.410, 1.693
Level 3 High school	1.130	0.563, 2.269	0.769	0.401, 1.475
Level 4 College/university	1.486	0.766, 2.884	0.853	0.460, 1.581
Diagnostic subtype
AS	–	–	–	–
PsA	0.908	0.573, 1.438	1.116	0.709, 1.918
U-SpA	0.843	0.462, 1.538	0.953	0.496, 1.831
Pain group
No chronic pain	–	–	–	–
Chronic regional pain	1.283	0.743, 2.217	1.872	0.984, 3.696
Chronic widespread pain	1.208	0.742, 1.968	2.366*	1.317, 4.250
Fatigue (NRS 0–10, best–worst)	1.138*	1.055, 1.227	1.246*	1.146, 1.355
General health (NRS 0–10, best–worst)	1.197*	1.091, 1.314	1.238*	1.125, 1.362
EQ-5D score (−0.549 to 1, 1 = full health)	0.116*	0.052, 0.261	0.103*	0.048, 0.221
BASFI (0–10, best–worst)	1.122*	1.035, 1.216	1.227*	1.131, 1.331
BASDAI (0–10, best–worst)	1.148*	1.020, 1.291	1.308*	1.157, 1.479
ASES Pain (10–100, low–high)	0.987*	0.977, 0.997	0.979*	0.969, 0.990
ASES Symptom (10–100, low–high)	0.974*	0.963, 0.984	0.963*	0.952, 0.975
HADS other (0–21, low–high)	1.225*	1.145, 1.311	1.184*	1.124, 1.248

HADS-Anxiety (HADS-A): 1181 stable vs 157 deteriorated patients; HADS-Depression (HADS-D): 1402 vs 99 deteriorated patients.

AS, ankylosing spondylitis; PsA, psoriatic arthritis; U-SpA, undifferentiated spondyloarthritis; NRS, numeric rating scale; EQ-5D, EuroQol 5 Dimensions; BASFI, Bath Ankylosing Spondylitis Functional Index; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; ASES, Arthritis Self-Efficacy Scale; OR, odds ratio; CI, confidence interval.

*Significant (p < 0.05) odds ratio.

Husted JA, Tom BD, Farewell VT, Gladman DD. Longitudinal study of the bidirectional association between pain and depressive symptoms in patients with psoriatic arthritis. Arthritis Care Res (Hoboken) 2012;64:758–65.

 PubMed Web of Science ®Google Scholar

Meesters JJ, Bremander A, Bergman S, Petersson IF, Turkiewicz A, Englund M. The risk for depression in patients with ankylosing spondylitis: a population-based cohort study. Arthritis Res Ther 2014;16:418.

 PubMed Web of Science ®Google Scholar

Brooks R. EuroQol: the current state of play. Health Policy 1996;37:53–72.

 PubMed Web of Science ®Google Scholar

Brionez TF, Assassi S, Reveille JD, Learch TJ, Diekman L, Ward MM, et al. Psychological correlates of self-reported functional limitation in patients with ankylosing spondylitis. Arthritis Res Ther 2009;11:R182.

 PubMed Web of Science ®Google Scholar

Haglund E, Bergman S, Petersson IF, Jacobsson LT, Strombeck B, Bremander A. Differences in physical activity patterns in patients with spondyloarthritis. Arthritis Care Res (Hoboken) 2012;64:1886–94.

 PubMed Web of Science ®Google Scholar

Calin A, Garrett S, Whitelock H, Kennedy LG, O’Hea J, Mallorie P, et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the bath ankylosing spondylitis functional index. J Rheumatol 1994;21:2281–5.

 PubMed Web of Science ®Google Scholar

Englund M, Joud A, Geborek P, Felson DT, Jacobsson LT, Petersson IF. Prevalence and incidence of rheumatoid arthritis in southern Sweden 2008 and their relation to prescribed biologics. Rheumatology (Oxford) 2010;49:1563–9.

 PubMed Web of Science ®Google Scholar

Haglund E, Bremander A, Bergman S, Jacobsson LT, Petersson IF. Work productivity in a population-based cohort of patients with spondyloarthritis. Rheumatology (Oxford) 2013;52:1708–14.

 PubMed Web of Science ®Google Scholar

Goulia P, Voulgari PV, Tsifetaki N, Andreoulakis E, Drosos AA, Carvalho AF, et al. Sense of coherence and self-sacrificing defense style as predictors of psychological distress and quality of life in rheumatoid arthritis: a 5-year prospective study. Rheumatol Int 2015;35:691–700.

 PubMed Web of Science ®Google Scholar

Eder L, Chandran V, Pellett F, Pollock R, Shanmugarajah S, Rosen CF, et al. IL13 gene polymorphism is a marker for psoriatic arthritis among psoriasis patients. Ann Rheum Dis 2011;70:1594–8.

 PubMed Web of Science ®Google Scholar

Geenen R, Newman S, Bossema ER, Vriezekolk JE, Boelen PA. Psychological interventions for patients with rheumatic diseases and anxiety or depression. Best Pract Res Clin Rheumatol 2012;26:305–19.

 PubMed Web of Science ®Google Scholar

Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 1990;33:160–72.

 PubMed Web of Science ®Google Scholar

Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the bath ankylosing spondylitis disease activity index. J Rheumatol 1994;21:2286–91.

 PubMed Web of Science ®Google Scholar

Durmus D, Sarisoy G, Alayli G, Kesmen H, Cetin E, Bilgici A, et al. Psychiatric symptoms in ankylosing spondylitis: their relationship with disease activity, functional capacity, pain and fatigue. Compr Psychiatry 2015;62:170–7.

 PubMed Web of Science ®Google Scholar

Hakkou J, Rostom S, Aissaoui N, Berrada KR, Abouqal R, Bahiri R, et al. Psychological status in Moroccan patients with ankylosing spondylitis and its relationships with disease parameters and quality of life. J Clin Rheumatol 2011;17:424–8.

 PubMed Web of Science ®Google Scholar

Kilic G, Kilic E, Ozgocmen S. Relationship between psychiatric status, self-reported outcome measures, and clinical parameters in axial spondyloarthritis. Medicine (Baltimore) 2014;93:e337.

 PubMed Web of Science ®Google Scholar