Depression Prevalent in Axial Spondyloarthritis Patients, Linked to Disease Severity, Review Shows

Depression is prevalent among patients with axial spondyloarthritis and correlates with more severe disease activity, according to a detailed review of literature.

The study, “The prevalence of depression in axial spondyloarthritis and its association with disease activity: a systematic review and meta-analysis,” was published in the journal Arthritis Research & Therapy.

Axial spondyloarthritis (axSpA) is the chronic inflammation of sacroiliac joints that connect the base of the spine to the hip bones and the spine itself. It is an umbrella term that describes both ankylosing spondylitis (radiographic axSpA, AS) and non-radiographic axSpA (nr-axSpA). Like other conditions for which chronic pain is a feature, depression is common among axSPA patients. However, the prevalence of depression and the impact of disease activity on patients’ mental health is unclear.

Researchers reviewed published data to identify and compare the prevalence of depression among patients with axSPA, AS, and nr-axSpA. They also evaluated the level of disease severity and functional impairment among patients with and without depression.

Aftera careful review of the literature discussing depression in axSpA, AS, and nr-axSpA patients, the team narrowed down the data set analyzed to a total of 15 published research articles and one abstract submitted to a conference. Of these, 14 included ankylosing spondylitis patients while the remaining two had nr-axSpA patients.

Cumulatively, information from 4,753 axSpA patients across all studies was re-analyzed, including information on patients grouped as having either AS (2,857) or nr-axSpa (334).

Researchers found that across all patient groups the prevalence of depression was similar, and depending on the criteria and thresholds used to analyze prevalence data, 11% to 64% of depression prevalence was reported across all studies.

The Hospital Anxiety and Depression Scale (HADS) is a commonly administered self-reporting tool for depression and emotional stress. A threshold of 11 or higher on the HADS total score is an indicator of depression.

The Zung Self-Rating Depression Scale (SDS) is also a psychological self-rating test to measure depression severity, where a threshold lower than or equal to 49 is interpreted as no depression, 50 to 69 means there is depression, and a score higher than 70 translates to severe depression.

Across all studies, the overall prevalence of mild depression using HADS was 38%, while the prevalence of at least moderate depression using HADS and SDS was 15% and 52%, respectively.

When looking at individual groups, the prevalence of mild depression (using HADS) in ankylosing spondylitis patients was also 38%, while prevalence of at least moderate depression using HADS and SDS was 18% and 52%, respectively. In nr-axSpA patients, only mild depression was observed (36%).

Overall, three disease activity scoring tools were used across the different studies to determine its correlation with depression. In all three, patients with depression had the worse disease activity.

Similarly, markedly higher functional impairment was noted in patients with depression in two different functional impairment assessment tools.

“Clinicians should be mindful of comorbid depression when managing axSpA patients, especially for younger patients and those with severe disease activity and functional impairment,” the researchers wrote.

“Further longitudinal studies are needed to explore the impact of depression on treatment outcomes and axSpA treatment on symptoms of depression,” they added.