THE PREVALENCE OF ANXIETY, DEPRESSION, AND SLEEP DISTURBANCES AMONG THE RHEUMATOID ARTHRITIS PATIENTS

Main Article Content

Zainab Waheed
Ume-kalsoom

Abstract

Objective:


To evaluate the prevalence of depression, anxiety and sleep disturbances among rheumatoid arthritis (RA) patients and gender disparities attending the outpatient clinics of a tertiary care hospital in Khyber Pakhtunkhwa, Pakistan.


Methodology:


The cross-sectional descriptive study was carried out on 250 patients visiting the orthopaedic OPD
of teaching hospitals of Khyber Pakhtunkhwa from June 2022 to February 2023. A purposive sampling technique
was used. Informed consent was taken from the patients. A questionnaire regarding anxiety, depression, and
sleep disturbance was given to the patients. Data were collected using a pre-validated scale, Hospital Anxiety and
Depression Scale (HADS).


Results: The study included 250 patients with a mean age of 41.89 ± 7.82. Most of the patients were female (64.0%), and the average disease duration was 8.6 ± 6.2 years. Most of the patients belonged to middle-class families. On the HADS scale, females reported increased anxiety (p=0.001) along with the depression level (p=0.001) compared to males. Similarly, females experienced significantly more sleep disturbances (p=0.001). However, duration of the disease was not found to be associated with the prevalence of anxiety, depression, or sleep disturbances.


Conclusion:


Rheumatoid arthritis (RA) is linked with adverse impacts on psychological health. The results indicate that rheumatoid arthritis patients had comorbid anxiety, depression, and sleep disturbances. However, females are at higher risk of such comorbidities.  


 

Article Details

How to Cite
1.
Waheed Z, Ume-kalsoom. THE PREVALENCE OF ANXIETY, DEPRESSION, AND SLEEP DISTURBANCES AMONG THE RHEUMATOID ARTHRITIS PATIENTS. J Postgrad Med Inst [Internet]. 2024 Feb. 17 [cited 2024 Nov. 4];38(1):54-8. Available from: https://jpmi.org.pk/index.php/jpmi/article/view/3282
Section
Original Article

References

Dai SM, Han XH, Zhao DB, Shi YQ, Liu Y, Meng JM. Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study. J Rheumatol. 2003;30(10):2245-51. PMID 14528524.

Gettings L. Psychological well-being in rheumatoid arthritis: a review of the literature. Musculoskelet Care. 2010;8(2):99-106. DOI: 10.1002/msc.171.

Kessler RC, Sampson NA, Berglund P, Gruber MJ, Al-Hamzawi A, Andrade L et al. Anxious and non-anxious major depressive disorder in the World Health Organization World Mental Health Surveys. Epidemiol Psychiatr Sci. 2015;24(3):210-26. DOI: 10.1017/S2045796015000189.

Hooten WM. Chronic pain and mental health disorders: shared neural mechanisms, epidemiology, and treatment. Proc. 2016;91(7):955-70 DOI: 10.1016/j.mayocp.2016.04.029.

McManus S, Bebbington PE, Jenkins R, Brugha T. Mental health and wellbeing in England: the adult psychiatric morbidity survey 2014. NHS digital; 2016.

Covic T, Cumming SR, Pallant JF, Manolios N, Emery P, Conaghan PG et al. 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 Psychiatry. 2012;12(1):6. DOI: 10.1186/1471-244X-12-6.

Cepoiu M, McCusker J, Cole MG, Sewitch M, Belzile E, Ciampi A. Recognition of depression by non-psychiatric physicians—a systematic literature review and meta-analysis. J Gen Intern Med. 2008;23(1):25-36. DOI: 10.1007/s11606-007-0428-5.

Rathbun AM, Reed GW, Harrold LR. The temporal relationship between depression and rheumatoid arthritis disease activity, treatment persistence and response: a systematic review. Rheumatology (Oxford). 2013;52(10):1785-94. DOI: 10.1093/rheumatology/kes356.

Nerurkar L, Siebert S, McInnes IB, Cavanagh J. Rheumatoid arthritis and depression: an inflammatory perspective. Lancet Psychiatry. 2019;6(2):164-73. DOI: 10.1016/S2215-0366(18)30255-4.

Lorton D, Lubahn CL, Zautra AJ, Bellinger DL. Proinflammatory cytokines and sickness behavior in rheumatic diseases. Curr Pharm Des. 2008;14(13):1242-60. DOI: 10.2174/138161208799316375.

Lasalvia A, Zoppei S, Van Bortel T, Bonetto C, Cristofalo D, Wahlbeck K et al. Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. Lancet. 2013;381(9860):55-62. DOI: 10.1016/S0140-6736(12)61379-8.

Silman AJ, Pearson JE. Epidemiology and genetics of rheumatoid arthritis. Arthritis Res. 2002;4;Suppl 3:S265-72. DOI: 10.1186/ar578.

Guo G, Fu T, Yin R, Zhang L, Zhang Q, Xia Y et al. Sleep quality in Chinese patients with rheumatoid arthritis: contributing factors and effects on health-related quality of life. Health Qual Life Outcomes. 2016;14(1):151. DOI: 10.1186/s12955-016-0550-3.

Farooqi A, Gibson T. Prevalence of the major rheumatic disorders in the adult population of north Pakistan. Br J Rheumatol. 1998;37(5):491-5. DOI: 10.1093/rheumatology/37.5.491.

Mustafa M, Bawazir Y, Merdad L, Wali S, Attar S, Fathaldin O et al. Frequency of sleep disorders in patients with rheumatoid arthritis. Open Access Rheumatol. 2019;11:163-71. DOI: 10.2147/OARRR.S201556.

Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey R, et al. European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Arthritis Rheumatol. 2019;71(9):1400-12. DOI: 10.1002/art.40930.

Machin AR, Babatunde O, Haththotuwa R, Scott I, Blagojevic-Bucknall M, Corp N et al. The association between anxiety and disease activity and quality of life in rheumatoid arthritis: a systematic review and meta-analysis. Clin Rheumatol. 2020;39(5):1471-82. DOI: 10.1007/s10067-019-04900-y.

Choudhary S, Tyagi A, Kumar V, Grover S. Prevalence of anxiety and depression in rheumatoid arthritis patients and comparison with control group- a case control study. Paripex Indian J Res. 2018.

El-Miedany YM, el-Rasheed AH. Is anxiety a more common disorder than depression in rheumatoid arthritis? Joint Bone Spine. 2002;69(3):300-6. DOI: 10.1016/s1297-319x(02)00368-8.

Silva CFR, Duarte C, Ferreira RJO, Santos E, da Silva JAP. Depression, disability and sleep disturbance are the main explanatory factors of fatigue in rheumatoid arthritis: a path analysis model. Clin Exp Rheumatol. 2020;38(2):314-21. DOI: 10.55563/clinexprheumatol/hkhbad.

Matcham F, Ali S, Irving K, Hotopf M, Chalder T. Are depression and anxiety associated with disease activity in rheumatoid arthritis? A prospective study. BMC Musculoskelet Disord. 2016;17(1):155. DOI: 10.1186/s12891-016-1011-1.

Matcham F, Norton S, Scott DL, Steer S, Hotopf M. Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis: secondary analysis of a randomized controlled trial. Rheumatology (Oxford). 2016;55(2):268-78. DOI: 10.1093/rheumatology/kev306.

Dickens C, McGowan L, Clark-Carter D, Creed F. Depression in rheumatoid arthritis: a systematic review of the literature with meta-analysis. Psychosom Med. 2002;64(1):52-60. DOI: 10.1097/00006842-200201000-00008.

Gamal RM, Mohamed ME, Hammam N, El Fetoh NA, Rashed AM, Furst DE. Preliminary study of the association of serum irisin levels with poor sleep quality in rheumatoid arthritis patients. Sleep Med. 2020;67:71-6. DOI: 10.1016/j.sleep.2019.10.021.

Austad C, Kvien TK, Olsen IC, Uhlig T. Sleep disturbance in patients with rheumatoid arthritis is related to fatigue, disease activity, and other patient-reported outcomes. Scand J Rheumatol. 2017;46(2):95-103. DOI: 10.3109/03009742.2016.1168482.

Power JD, Perruccio AV, Badley EM. Pain as a mediator of sleep problems in arthritis and other chronic conditions. Arthritis Rheum. 2005;53(6):911-9. DOI: 10.1002/art.21584.

Abbasi M, Yazdi Z, Rezaie N. Sleep disturbances in patients with rheumatoid arthritis. Niger J Med. 2013;22(3):181-6.

Westhovens R, Van der Elst K, Matthys A, Tran M, Gilloteau I. Sleep problems in patients with rheumatoid arthritis. J Rheumatol. 2014;41(1):31-40. DOI: 10.3899/jrheum.130430.

Miettinen T, Sverloff J, Lappalainen OP, Linton SJ, Sipilä K, Kalso E. Sleep problems in pain patients entering tertiary pain care: the role of pain-related anxiety, medication use, self-reported diseases, and sleep disorders. Pain. 2022;163(7):e812-20. DOI: 10.1097/j.pain.0000000000002497.

Hammam N, Gamal RM, Rashed AM, Elfetoh NA, Mosad E, Khedr EM. Fatigue in rheumatoid arthritis patients: association with sleep quality, mood status, and disease activity. Reumatol Clin. 2020 Sep 1;16(5 Pt 1):339-44. DOI: 10.1016/j.reuma.2018.07.010.