Determinants of psychological well-being in axial spondyloarthritis: An analysis based on linked claims and patient-reported survey data

Abstract

Objectives the aim of this study was to assess the psychological well-being and to analyse factors associated with depressive symptoms in axial spondyloarthritis (axSpA). Methods A stratified random sample of subjects with a diagnosis of axSpA (International Classification of diseases, tenth revision, German Modification M45) was drawn from health insurance data in Germany. these persons received a postal questionnaire on disease-related, psychological and lifestyle factors as well as socioeconomic status. Additional information to verify the axSpA diagnosis was also collected. the psychological well-being was assessed by means of the 5-item WHo Well-Being Index (WHo-5), which is considered a screening tool for depression. the following established cut-offs on the WHo-5 were applied: >50: good well-being, no depressive symptoms; 29–50: mild depressive symptoms; ≤28: moderate-to-severe depressive symptoms. Information on comorbidities, drug prescriptions and non-pharmacological treatment was retrieved from claims data and linked to the questionnaire data. results A total of 1736 persons with a confirmed axSpA diagnosis were included. Using the cut-offs on the WHo-5, 533 persons (31%) were found to have moderate-to-severe depressive symptoms, 479 (28%) had mild depressive symptoms and 724 (42%) had a good well-being. Multivariable logistic regression revealed that higher disease activity, higher level of functional impairment, lower income, self-reported stress and lack of exercise, and younger age represent factors associated with moderate-to-severe depressive symptoms. Conclusions the prevalence of depressive symptoms in axSpA subjects is high and associated with disease-related parameters, socioeconomic status and lifestyle factors. these findings highlight the need for the careful evaluation of depressive symptoms as a part of the management strategy for axSpA.