Experts Discuss Rheumatologists’ Role in Treating Depression, Anxiety and Psychological Comorbidities in Their Patients

“Rheumatologic diseases come with emotional fallout. They can change the course of a person’s life and adversely affect their sense of self. We can add to that neurobiological factors, with new evidence suggesting depression itself may be a type of inflammatory disease,” she says.

Dr. Evers

Not all rheumatology patients have depression, notes Andrea Evers, PhD, professor of health psychology and chair of the Health, Medical and Neuropsychology Unit at Leiden University in The Netherlands. “A majority of our patients can handle a condition like rheumatoid arthritis in their lives with their existing coping resources. But rheumatologists struggle with a subgroup of patients who are prone to depression,” she says. “Sometimes, the mental health issue is independent of the disease. But we know people with high levels of rheumatic disease are already experiencing stress, which in turn has a close relationship with rheumatologic disease.”

What Does the Research Tell Us?

Research has demonstrated prevalence of depression and anxiety in such conditions as rheumatoid arthritis at double the rates in the general population, and milder levels of psychological distress are even more common.¹ Studies report ranges of depression from 5–20% in patients with RA.²

Symptoms of depression and anxiety are also associated with poorer health outcomes, increased disability and reduced treatment response, and with worse health-related quality of life.^3,4 But only a fraction of those with depression and anxiety receive treatment for those symptoms.⁵

Fatigue in RA is also associated with psychological correlates, especially poor mood.⁶ There is a relationship between stress and exacerbation of RA, and between resilience factors and RA management.⁷ Researchers have also documented the impact of psychological factors on patients’ responses to RA treatment.⁸

Loneliness has been shown to have an impact on patients’ daily pain in fibromyalgia, and loneliness and lack of social support are possible risk factors for worse physical and psychological functioning in a variety of somatic conditions, including RA and fibromyalgia.^9,10 Rheumatology research has even identified connections with premature mortality. One recent study suggests treatment with antidepressants can lead to RA remission, and others have asked if it is possible to accurately identify a fibromyalgia or RA personality.^11-13

A lot of people are trying to figure out cause and effect, says Faith Matcham, PhD, CPsychol, a post-doctoral research associate at the Institute of Psychiatry, Psychology and Neuroscience at Kings College, London, England. “I don’t think that’s the most important question, but rather how do these two things relate to each other? If you have one, how does it interact with the other?” she explains.