Alyssa Howren, Eric C. Sayre, J. Antonio Avina‐Zubieta, Joseph H. Puyat, Deborah Da Costa, Hui Xie, Eileen Davidson, Mary A. De Vera

“What came first?” Population‐based evaluation of health care encounters for depression and anxiety before and after inflammatory arthritis diagnosis: Disentangling the relationship between mental health and arthritis

  • Rheumatology
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ObjectiveDescribe patterns of depression and anxiety health care use pre‐ and post‐diagnosis among patients with inflammatory arthritis (IA), namely ankylosing spondylitis (AS), psoriatic arthritis (PsA), and rheumatoid arthritis (RA).MethodsWe used population‐based linked administrative health data from British Columbia, Canada to build a cohort of patients (≥18 years) with incident IA and individuals without IA (‘IA‐free controls’) matched on age and sex. We computed the proportion of IA patients and controls having ≥1 depression or ≥1 anxiety health care encounter and use of ≥1 antidepressant or ≥1 anxiolytic in each yearly interval 5‐years pre‐ and post‐IA diagnosis. We used multivariable logistic regression models to evaluate the association between IA status and aforementioned depression and anxiety health care use outcomes in each yearly interval.Results80,238 individuals with IA (62.9% female; mean age 56.2 ±16.7 years) and 80,238 IA‐free controls (62.9% female; mean age 56.2 ±16.6 years) were identified between 01/01/2001 to 03/31/2018. Individuals with IA had significantly increased odds of depression and anxiety health care encounters and dispensation of antidepressants and anxiolytics, for each yearly interval pre‐ and post‐diagnosis. Adjusted odds ratios (aORs) were highest in the year immediately before (≥1 depression visit: aOR 1.61, 95% confidence interval [CI] 1.55 to 1.66; ≥1 anxiolytic: aOR 1.71, 95% CI 1.66 to 1.77) or after (≥1 antidepressant: aOR 1.95, 95% CI 1.89 to 2.00) IA diagnosis.ConclusionFindings suggest a role for depression and anxiety in characterizing the IA prodrome and generate hypotheses regarding overlapping biopsychosocial processes that link IA and mental health comorbidities.image

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