Depression, anxiety and cognitive function in persons with inflammatory rheumatic diseases: cross-sectional results from the German National Cohort (NAKO)

Abstract

Objective: To assess the presence of mental health disorders in persons with rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE) and Sjögren's disease (SjD) (all: inflammatory rheumatic disease, iRMD) in a population-based cohort.

Methods: Baseline data from 101 601 participants of the German National Cohort (NAKO) were analysed. Self-reported physician's diagnoses of depression and anxiety, the depression scale of the Patient Health Questionnaire (PHQ-9), the Generalised Anxiety Disorder Symptoms Scale (GAD-7), the depression section of the Mini-International Neuropsychiatric Interview (MINI) and cognitive tests on memory and executive functions were analysed. Results of participants with iRMD were compared with participants with osteoarthritis (OA), stratified by age and sex. Cognitive function was described for iRMD and OA using a linear regression model, adjusted for sex and education.

Results: n=3257 participants (3.2%) had an iRMD (2.3% RA, 0.6% AS, 0.5% PsA, 0.2% SLE, 0.1% SjD) and n=24 030 (24%) had OA. Physicians' diagnoses of depression (26% vs 21%), anxiety (15% vs 11%), current depressive (PHQ-9 ≥10: 13% vs 9.0%) and anxiety symptoms (GAD-7 ≥10: 8.6% vs 5.8%) were more frequent in iRMDs compared with OA. In all age groups, women were more often affected than men. Linear regression models showed no differences in neuropsychological test results between iRMD and OA.

Conclusion: Individuals with iRMD frequently experience mental disorders. The study provides an assessment of both self-report and test-based occurrences in this group. Depression and anxiety are more frequent in iRMD compared with OA, whereas levels of cognitive dysfunction were comparable.

Keywords: Sjogren's syndrome; arthritis, rheumatoid; axial spondyloarthritis; epidemiology; lupus erythematosus, systemic.

Figure 1. Flow chart. AS, ankylosing spondylitis; iRMD, inflammatory rheumatic disease; NAKO, German National Cohort; OA, osteoarthritis; PsA, psoriatic arthritis; RA, rheumatoid arthritis; SjD, Sjögren’s disease; SLE, systemic lupus erythematosus.

Figure 2. Depression diagnosis and symptoms by diagnosis. Percentage of persons with a self-reported lifetime diagnosis of depression and current depressive symptoms measured by the Patient Health Questionnaire (PHQ-9 ≥10) by age and sex. PHQ-9 Depression Scale of the Patient Health Questionnaire age groups with case numbers ≤10 are not shown.

Figure 3. Cognitive performance in iRMD and OA. Results (least square means for ages 20, 30, 40, 50, 60 and 70) from linear regression models with iRMD status, sex, age and education as covariates. Immediate word recall: difference between recalled words (range 0–12) at t1 and t2 (immediate recall). Delayed word recall: difference between words at t2 (immediate recall) and t3 (delayed recall). iRMD, inflammatory rheumatic disease; OA, osteoarthritis.