Primary care patients with inflammatory disease, particularly those with early-onset disease, demonstrate elevated rates of depression and anxiety, according to data published in the Annals of the Rheumatic Diseases.
“The study identified that patients diagnosed with diverse chronic inflammatory disorders were at substantive risk of developing depression or anxiety,” Alexandru Dregan, PhD, MSc, of King’s College London, told Healio Rheumatology. “Importantly, patients with a younger age at inflammatory disorder onset presented the highest risk of developing depression or anxiety.”
To analyze the risks for depression and anxiety among primary care patients with inflammatory diseases, Dregan and colleagues conducted a prospective, matched cohort study of data in the Clinical Practice Research Datalink (CPRD). According to the researchers, the CPRD is among the world’s largest electronic medical records databases and includes routine primary care information on more than 14 million patients from 675 practices in the U.K. National Health Service.
Primary care patients with inflammatory disease demonstrate elevated rates of depression and anxiety, according to data.
The researchers evaluated data on 180,163 adults diagnosed with first-ever psoriasis, Crohn’s disease or ulcerative colitis, rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis or systemic vasculitis from Jan. 1, 2001, through September 2016. In addition, all were without a diagnosis of anxiety or depression at the time of inflammatory disease diagnosis. Theses patients were matched based by age, gender, practice and index date with 358,544 control individuals without a diagnosis of inflammatory disease.
The primary outcome was a new medical code for either a depression or anxiety diagnosis. The median follow-up duration was 4 years for both patients and controls.
According to the researchers, incidence rates for depression in the patient group ranged from 14 per 1,000 person-years, for patients with severe psoriasis, to nine per 1,000 person-year, among those with systemic vasculitis. These rates were substantially higher than those in the control group, which ranged from five per 1,000 person-years to seven per 1,000 person-years.
Hazard ratios for multiple depression and anxiety events were 16% higher among patients with inflammatory diseases, compared with those in the control group (HR = 1.16; 95%CI, 1.12-1.21). In addition, incidence rates for depression and anxiety were strongly associated with inflammatory disease onset age. Among patients who developed their inflammatory disease prior to 40 years of age, the HR estimate for depression was 1.9 (95% CI, 1.66-2.17). For those whose age of onset was 60 years or older, the estimated HR was 0.93 (95% CI, 0.0-1.09).
“The high risk of depression and anxiety means that clinicians should be vigilant for early symptoms of depressive or anxiety among primary care patients diagnosed with inflammatory disorders,” Dregan said. “The higher rates of depression and anxiety among younger people support the development of targeted preventative interventions.” – by Jason Laday
Disclosure: Dregan reports no relevant financial disclosures. Please see the study for all other relevant financial disclosures.