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Cynthia Crowson, PhD, and colleagues examined data over three decades to determine if anxiety and depression were higher in patients with rheumatoid arthritis.

More studies are bringing attention to the mental health component of chronic diseases such as rheumatoid arthritis (RA). Cynthia Crowson, PhD, and colleagues developed a population-based study examining data over three decades to determine if anxiety and depression rates were heightened among patients with RA. The study’s results were published in the Journal of Rheumatology.

Dr. Crowson spoke with Physician’s Weekly (PW) about the findings’ applicability to daily practice.

PW: What inspired you to investigate mental health trends in patients with RA?

Dr. Crowson: Historically, people with RA have had more depression than those without RA. However, newer medications have reduced joint damage and have improved physical functioning for people with RA. We examined time trends in the occurrence of depression because we were hopeful that these treatment advances would lead to less depression for people with RA. 

Why do you think anxiety and depression assessment is often overlooked in RA? 

Assessment of anxiety and depression in people with RA is often overlooked because the focus on controlling the physical symptoms and disease progression of RA can sometimes reduce recognition of mental health conditions. Additionally, healthcare practitioners may not be adequately trained to identify or address mental health issues within this patient population, resulting in a gap in comprehensive care.

What did your study reveal about the current landscape of anxiety and depression in RA?

One of the most important findings from our work is the lack of improvement in depression despite the advances in RA treatment. Another important finding is the significant increase in the rates of anxiety and concomitant anxiety and depression among patients with RA from 2005-2014 compared with 1985-1994. Additionally, we found that the risk of receiving a new diagnosis of anxiety or concomitant anxiety and depression is progressively increasing, especially among people with seropositive RA.

How can clinicians incorporate these findings into practice?

Integrating these findings into practice involves developing comprehensive care models that address the physical and mental health needs of people with RA. Systematic screening for anxiety and depression should be implemented, and regular mental health assessments should become a standard part of RA treatment protocols. Such integrated approaches will ensure better patient outcomes and overall well-being.

Why is it important to address gaps in mental healthcare?

Depression and anxiety are particularly important because, in addition to their direct negative impacts on health and economic burdens, they also negatively impact the outcomes of other conditions, like RA, and they are associated with increased mortality.

Future research should focus on understanding the underlying mechanisms that contribute to the increased prevalence of anxiety and depression among people with RA. Additionally, exploring the effectiveness of integrated care models in improving both physical and mental health outcomes is crucial. Identifying specific factors that may predict mental health conditions in this population can help develop targeted interventions and enhance patient care.

Healthcare practitioners must recognize that RA impacts more than just physical health. The significant increase in anxiety and depression among patients with RA underscores the need for comprehensive care models. Implementing systematic screening can make a considerable difference in patient outcomes and overall well-being. We advocate for integrated approaches that address both physical and mental health needs, ensuring a holistic treatment protocol for people with RA.