Mental Health Matters for People With Arthritis

 

Scientific Study Title: 

Mapping the epidemiology and the role of treatments in mental health complications in inflammatory arthritis (MATTERS)

 

Study Start Date: 

January 2019

 

End Date:

December 2021

 

Why Did We Do This Research?

There is limited research on the link between arthritis and mental health. The goal of this research was to better understand arthritis and mental health. Arthritis and psychiatric conditions like depression are closely connected, and inflammation seems to play a big role in both. However, even though this link is important, research on this issue is limited. This was one of the first studies of its kind in Canada on mental health in people with arthritis. We did this research in hopes of improving awareness of how arthritis affects mental health and how we can improve care for patients.

 

What Did We Do?

We used health data from British Columbia, Canada, on doctors’ visits, hospitalizations, and prescriptions, to conduct two studies.

We wanted to understand:

  1. What does someone’s mental health look like when they’re first diagnosed with arthritis, and did the mental health challenges start before or after the arthritis? (study 1)
  2. Are people with arthritis who also have depression or anxiety getting the mental health care they need—including both medications and counselling—compared to those without arthritis? (study 2)

 

What Did We Find?

Study 1: We found that people had more doctor visits for depression and anxiety in the five years leading up to their arthritis diagnosis, with the most visits happening in the year they were diagnosed. We found the same trends with respect to medications, including antidepressants. We also found that this was most common among female patients with arthritis than male patients. The increase in doctor visits and medications for depression and anxiety before an arthritis diagnosis might be because it takes time to figure out what’s really going on. These delays can leave people feeling stressed or overwhelmed. It’s also possible that early symptoms of arthritis, like feeling tired, sore muscles, or weight changes, are mistaken for signs of depression or anxiety, which could lead to a misdiagnosis before the arthritis is properly identified.

Study 2: We found that 50% of people with arthritis received adequate medication treatment for depression and anxiety, which is similar to findings for people who don’t have arthritis. However, only 20% of people with arthritis received adequate psychological treatment. When depression and anxiety aren’t properly treated in people with arthritis, it can affect not just their mental health but also make their physical health worse.

 

What is the Impact?

This research helps us better understand how arthritis and mental health problems like depression and anxiety often go hand in hand. It also shows that many people with arthritis, when diagnosed with depression and anxiety, are not getting the mental health support they need. Treating mental health is just as important as managing physical symptoms. We need to raise awareness and advocate for better mental health care for people with arthritis, so they receive the full support they need for their overall well-being.

 

Infographic 

Click to enlarge image.

Who Was Involved?

The research team included practicing rheumatologists and clinician researchers, research scientists with expertise in epidemiology, health services and biostatistics, a PhD trainee, and a patient-research partner.

 

The Research Team

 
Principal Investigators:         

Mary De Vera, MSc, PhD, Senior Scientist, Pharmacoepidemiology, Associate Director of Training, Arthritis Research Canada (University of British Columbia)

 
Co-investigators:

Deborah Da Costa, PhD, Senior Scientist, Psychology, Arthritis Research Canada (McGill University)

John Esdaile, MD, MPH, FRCPC, FCAHS, MACR, Scientific Director Emeritus, Arthritis Research Canada (University of British Columbia)

Joseph H. Puyat, School of Population and Public Health (University of British Columbia)

Kamran Shojania, MD, FRCPC, Clinical Trialist, Rheumatology, Arthritis Research Canada (University of British Columbia)

J. Antonio Avina-Zubieta, MD, MSc, PhD, FRCPC, Senior Scientist, Rheumatology, Arthritis Research Canada (University of British Columbia)

Alyssa Howren, BS, MSc, PhD, Postdoctoral Scholar (Stanford University), Former Arthritis Research Canada Trainee

Eileen Davidson, Arthritis Research Canada Arthritis Patient Advisory Board Member

 

Funding Agency:

The Arthritis Society

 

Publications

  • Howren A, Avina-Zubieta JA, Puyat JH, Esdaile JM, Da Costa D, De Vera MA. Defining depression and anxiety in individuals with inflammatory arthritis using administrative health databases: A systematic review. Arthritis Care Res (Hoboken). 2020 Feb;72(2):243-255. doi: 10.1002/acr.24048. Epub 2020 Jan 9.
  • Howren A, Bowie D, Choi HK, Rai SK, De Vera MA. Epidemiology of depression and anxiety in gout: A systematic review and meta-analysis. J Rheumatol. 2020 Mar 1. pii: jrheum.190974. doi: 10.3899/jrheum.190974. [Epub ahead of print].
  • Park JY, Howren A, Zusman EZ, Esdaile JM, De Vera MA. The incidence of depression and anxiety in patients with ankylosing spondylitis: A systematic review and meta-analysis. Accepted BMC Rheumatology. 2019 Dec 23.
  • Zusman EZ, Howren AM, Park JYE, Dutz J, De Vera MA. Epidemiology of depression and anxiety in patients with psoriatic arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum. 2020 Feb 13. pii: S0049-0172(20)30020-2. doi: 10.1016/j.semarthrit.2020.02.001. [Epub ahead of print].
  • Howren A, Sayre EC, Avina-Zubieta JA, Puyat JH, Da Costa D, Xie H, Davidson E, Gupta A, De Vera MA. Do individuals with inflammatory arthritis receive minimally adequate treatment for incident depression and anxiety: A population-based study. Arthritis Res Ther. 2025 Jan. 21;27(1):13. doi:10.1186/s13075-024-03466-8.
  • HowrenA, Sayre EC, Avina-Zubieta JA, Puyat JH, Da Costa D, Xie H, Davidson E, De Vera MA. 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. Arthritis Care Res (Hoboken). 2024 May;76(5):743-752. doi: 10.1002/acr.25294. Epub 2024 Feb 29.