Arthritis & Mental Health: It’s Complicated
People living with arthritis are more likely to experience mental health issues. In fact, up to 70% of individuals diagnosed with rheumatoid arthritis report having anxiety and up to 38% say they experience depression. In comparison, 25% of Canadians over age 18 live with symptoms of depression, anxiety and post-traumatic stress disorder. So, why are people with rheumatoid arthritis struggling with mental health more than the average Canadian?
Recent research points to inflammation for answers. However, according to Arthritis Research Canada’s Research Scientist, Dr. Mary De Vera, it’s a chicken-and-egg problem.
“Arthritis symptoms can lead to anxiety and depression and anxiety and depression can make arthritis symptoms worse,” she said. “There is a complex interplay between these conditions and we are looking at how improving arthritis itself can lead to better mental health.”
While arthritis research has historically focused on the physical aspects of the disease – like fatigue, pain and inflammation – Arthritis Research Canada’s scientists are switching gears to look at the whole picture. Research teams are working to understand the connection between arthritis, physical health and mental health in order to improve care and quality of life.
Origins in Inflammation
Studies have revealed that central nervous system inflammatory responses play a role in the development of mental health disorders. In other words, like arthritis, there may be an inflammatory basis for anxiety and depression.
“The problem is that we don’t know what comes first for most patients – the arthritis or the mental health complications,” De Vera said.
To understand the complicated relationship between arthritis and mental health, De Vera’s team is examining big data. They are looking at when people go to the hospital, see a doctor and experience complications. They are asking questions about when depression and anxiety is diagnosed and how it is managed alongside arthritis treatments.
“In society, we always want to separate physical and mental health, but we can’t because they are connected,” De Vera said. “Our research seeks to better understand mental health complications in arthritis and raise awareness to improve care.”
People living with arthritis often express a lack of support and validation from healthcare professionals when it comes to mental health. De Vera added that physicians are the first line of acknowledgement and their response can make a big difference – especially for people who are newly diagnosed with inflammatory arthritis.
Sickness and Stress
Many people with rheumatoid arthritis link the onset of their disease to recent, stressful life events like divorce, loss of a loved one or job, and other serious health problems.
“We know that stress makes us more susceptible to illnesses like colds and the flu,” said Dr. Susan Bartlett, a Research Scientist at Arthritis Research Canada and a licensed psychologist. “We wanted to find out whether stressful life events are more common in adults in the year before their rheumatoid arthritis diagnosis.”
Bartlett’s research used data from the Canadian Early Arthritis Cohort study (CATCH), which starts collecting data when people are diagnosed with rheumatoid arthritis or inflammatory arthritis and follows them over time. It is the largest collection of newly diagnosed RA patients in the world and the only Canada-wide early arthritis cohort study that is following people with new onset inflammatory or rheumatoid arthritis over time to examine the course of their disease and their response to the treatments provided by their healthcare teams.
Bartlett’s team found that 52 per cent of people in the CATCH cohort reported having experienced a major stressor in the past year. In the general population, that number was only 20 per cent.
“People who had a recent stressor felt much worse,” Bartlett said. “They had higher levels of pain, fatigue, sleep issues, depressive symptoms, and an overall impaired quality of life.”
Even one year later, individuals who experienced two or more stressors were still dealing with increased pain and fatigue, sleep issues and an overall lower quality of life than people who did not have stressors.
Bartlett said these findings reveal a pressing need for people, especially individuals living with rheumatoid arthritis, to find strategies for managing stress.
“Exercise, stay connected with people, use breathing exercises, make sure work isn’t consuming your life, set aside time for things you enjoy, and start the mental health discussion with your rheumatologist” she said. “Your physicians can steer you to the right community resources.”
Sleep for a Strong Mind
There is a very important relationship between sleep and anxiety and depression, according to Dr. Deborah Da Costa, a Research Scientist at Arthritis Research Canada.
At least 70 per cent of people with arthritis experience insomnia. They struggle to fall asleep, stay asleep or wake early. Yet, only half of people who have arthritis, and struggle with sleep, talk to their doctors about it. And when it is treated, hypnotics are typically prescribed to induce sleep. This medication is not intended for daily, prolonged use and can lead to side effects and tolerance, which means it can stop working.
Sleep experts recommend using cognitive behavioural therapy for insomnia (CBTi), which involves learning new strategies and behaviours to promote sleep rather than medications. However, CBTi is not widely available in Canada. We’re working to change this by tailoring and testing a CBTi program for people with arthritis that is delivered online.