Abstract
OBJECTIVE: Describe patterns of depression and anxiety health care use pre- and post-diagnosis among patients with inflammatory arthritis (IA), namely ankylosing spondylitis (AS), psoriatic arthritis (PsA), and rheumatoid arthritis (RA). METHODS: We used population-based linked administrative health data from British Columbia, Canada to build a cohort of patients (≥18 years) with incident IA and individuals without IA ('IA-free controls') matched on age and sex. We computed the proportion of IA patients and controls having ≥1 depression or ≥1 anxiety health care encounter and use of ≥1 antidepressant or ≥1 anxiolytic in each yearly interval 5-years pre- and post-IA diagnosis. We used multivariable logistic regression models to evaluate the association between IA status and aforementioned depression and anxiety health care use outcomes in each yearly interval. RESULTS: 80,238 individuals with IA (62.9% female; mean age 56.2 ±16.7 years) and 80,238 IA-free controls (62.9% female; mean age 56.2 ±16.6 years) were identified between 01/01/2001 to 03/31/2018. Individuals with IA had significantly increased odds of depression and anxiety health care encounters and dispensation of antidepressants and anxiolytics, for each yearly interval pre- and post-diagnosis. Adjusted odds ratios (aORs) were highest in the year immediately before (≥1 depression visit: aOR 1.61, 95% confidence interval CI 1.55 to 1.66; ≥1 anxiolytic: aOR 1.71, 95% CI 1.66 to 1.77) or after (≥1 antidepressant: aOR 1.95, 95% CI 1.89 to 2.00) IA diagnosis. CONCLUSION: Findings suggest a role for depression and anxiety in characterizing the IA prodrome and generate hypotheses regarding overlapping biopsychosocial processes that link IA and mental health comorbidities.
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