Psychological distress over 12 months post-diagnosis in an early inflammatory arthritis cohort

Abstract

Abstract Objectives People with inflammatory arthritis (IA) experience worsened mental wellbeing alongside disease progression. Using the National Early Inflammatory Arthritis Audit (NEIAA), we assessed trends in psychological distress during the 12 months following IA diagnosis, mapping these against clinical outcomes to identify associations. Methods This is a prospective study of people recruited to NEIAA receiving an IA diagnosis and completing the baseline patient survey. Patient-reported outcomes (PROs) at baseline, 3 months and 12 months were collected, including psychological distress [assessed using Patient Health Questionnaire Anxiety and Depression Screener (PHQ4ADS)]. Mixed effects linear regression models estimated associations between predictor variables with psychological distress at baseline and over time. Results Of 6873 eligible patients, 3451 (50.2%) showed psychological distress at baseline. Of those completing follow-ups, 30.0% and 24.1% were distressed at 3 months and 12 months, respectively. Higher psychological distress at diagnosis was more commonly reported by younger, female and non-White patients. Clinical factors, including higher counts of comorbidities, prior depression and higher disease activity at diagnosis were associated with higher distress. Higher distress at baseline was associated with poorer outcomes over time in quality of life, disability, work performance, disease activity, as well as reduced likelihood of achieving good treatment response by EULAR criteria. Conclusion Half of patients with IA show significant mental health comorbidity at presentation, which associated with worse disease outcomes and quality of life. Screening for anxiety and depression should be a universal standard, and access to effective mood therapies alongside arthritis treatments is essential. Strategies should be culturally valid and consider multi-morbidities.