i049 The importance of identifying and managing co-morbid anxiety and depression in people with rheumatological conditions

Abstract

Anxiety and depression are common mental disorders and major contributors to the overall global burden of disease. Depression is a risk factor for suicide. Where anxiety and depression are co-morbid with a long term physical condition, the morbidity and mortality from the long-term condition(s) are worsened. Anxiety and depression are commonly co-morbid with inflammatory arthritis, often un-detected and under-treated, and can lead to reduced treatment response, and increased morbidity and mortality. There is a good evidence-base for the effectiveness of individual treatments for people with anxiety and depression, but there are barriers to access for treatment, including stigma associated with mental disorders, normalisation of symptoms by both patients and health care professionals, inaccurate assessment, reliance on prescribing antidepressants, and lack of commissioned services offering evidence-based talking treatments. These barriers are exacerbated when anxiety and depression are co-morbid with long-term conditions. Most people with depression will be managed in primary care, without recourse to specialist mental health services. Collaborative care, incorporating a multiprofessional approach to patient care; a structured management plan; scheduled patient follow-ups; and enhanced communication has the potential to improve the management of people with co-morbid depression and anxiety. This presentation will use cases to illustrate approaches to the detection and management of people with inflammatory arthritis and co-morbid anxiety and depression, and make suggestions to improve both patient outcomes and relationships across the primary/specialist care interface.