The prevalence of depression in axial spondyloarthritis and its association with disease activity: a systematic review and meta-analysis

Zhao, S ORCID: 0000-0002-3558-7353, Thong, Daniel, Miller, Natasha, Duffield, Stephen, Hughes, David ORCID: 0000-0002-1287-9994, Chadwick, Laura ORCID: 0000-0001-6246-9558 and Goodson, Nicola ORCID: 0000-0003-0714-3568 (2018) The prevalence of depression in axial spondyloarthritis and its association with disease activity: a systematic review and meta-analysis. Arthritis Research and Therapy, 20 (1). 140-.

Text Depression in axSpA.pdf - Published version Download (991kB)

Abstract

Background Depression is common among patients with axial spondyloarthritis (axSpA), but reports of its prevalence are highly variable. We performed a systematic review to (i) describe the prevalence of depression in axSpA, (ii) compare its prevalence between axSpA, ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA) cohorts, and (iii) compare disease activity and functional impairment between those with and without depression. Methods We searched Medline, PubMed, Web of Science, PsycINFO, CINAHL Plus, the Cochrane library and conference abstracts of the European League Against Rheumatism, British Society for Rheumatology and American College of Rheumatology using a predefined protocol in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Meta-analysis was performed using quality-effects model. Results Fifteen original articles and one abstract were included for analysis; 14 studies described AS cohorts and two nr-axSpA. Three screening criteria and one diagnostic criterion were used to define depression. Prevalence ranged from 11 to 64% depending on criteria and thresholds used. Pooled prevalence of at least moderate depression was 15% using the Hospital Anxiety and Depression Scale (HADS) threshold of ≥ 11. The prevalence of depression was similar between axSpA, AS and nr-axSpA cohorts. Patients with depression had significantly worse disease activity, including higher BASDAI by 1.4 units (95% CI 1.0 to 1.9), ASDAS by 0.5 units (95% CI 0.3 to 0.7) and ESR by 3.5 mm/h (95% CI 0.6 to 6.4). They also had greater functional impairment with higher BASFI and BASMI by 1.2 units (95% CI 0.6 to 1.8) and 0.6 units (95% CI 0.3 to 0.8), respectively. Mean age of each study cohort inversely correlated with depression prevalence. Conclusions Depression is common among axSpA patients and is associated with more severe disease activity and functional impairment. Identifying and managing depression should form part of their holistic care. Further longitudinal studies are needed to explore the impact of depression on treatment outcomes and axSpA treatment on symptoms of depression.

Item Type:	Article
Uncontrolled Keywords:	Axial spondyloarthritis, Ankylosing spondylitis, Depression, Prevalence, Mental health, Comorbidity, Meta-analysis, Disease activity, Functional impairment
Depositing User:	Symplectic Admin
Date Deposited:	18 Jul 2018 07:37
Last Modified:	19 Jan 2023 01:30
DOI:	10.1186/s13075-018-1644-6
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3023887