Objectives To assess the prevalence of depression in Moroccan patients with ankylosing spondylitis (AS); and its relationships with disease-related parameters of activity, severity and quality of life (QoL).
Methods 110 patients with AS (67 men and 43 women) according to the modified New York Classification criteria were consecutively included in this cross-sectional study. Patients with previous psychological diseases or antidepressant treatment were excluded. To assess depression, the Patient Health Questionnaire depression scale (PHQ-9) was applied. The evaluation included: sociodemographic data, age at onset, peripheral and axial pain (on visual analogue scale (VAS)), treatments (doses and duration), disease activity (Bath Ankylosing Spondylitis Disease Activity Index), functional disability (Bath Ankylosing Spondylitis Functional Index), spinal mobility (Bath Ankylosing Spondylitis Metrology Index (BASMI)), radiographic damage (Bath Ankylosing Spondylitis Radiologic Index (BASRI)), hip involvement (BASRI-Hip), enthesitis (Maastricht Ankylosing Spondylitis Enthesis Score (MASES)), fatigue (on a 0-100 VAS) and QoL (SF-36 generic instrument). Erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) were determined as biologic signs of inflammation. Comparisons were assessed by the ANOVAs analysis of variance and correlations were evaluated with the Pearson correlation coefficient completed with regression models analysis.
Results In our data, 51 (46.3%) patients have major depressive syndrome, 36 (32.7%) have minor depressive syndrome and 23 (20.9%) have no depressive syndrome. The mean total score of PHQ-9 was 20.03±11.05 indicating severe depressive symptoms. Severe depression was associated with disease duration, diagnosis delay, axial pain intensity, number of tender and swollen peripheral joints, high clinical and biological disease activity (BASDAI, ESR and CRP), severe enthesitis, limited spinal mobility, functional disability, fatigue scores and the presence of hip involvement (for all p≤0.01). There were significant association between high scores of depression and the deterioration of physical as well as mental domains of QoL (for all p<0.001). There were no differences in depressive symptoms according to age, gender, educational level, structural damage or treatment. Patients with low socioeconomic status had higher scores of depression (p=0.024). In multiple regression analysis, the main factors associated with increased scores of PHQ-9 were: diagnosis delay (R2=1.083), high number of tender joints (R2=0.745), severity of enthesitis (R2=0.401), high levels of CRP (R2=0.639); altered functional status (R2=1.433) and the scores of BASRI-Hip (R2=0.923) (for all p≤0.01).
Conclusions In our data, we state the high prevalence of depressive syndrome among our AS which influenced negatively the patients’ QoL. Diagnosis delay, functional impairment, disease activity, enthesitis and the involvement of the hip were the main factors associated with high depression scores. Evaluating and recognizing relationships between depression and disease parameters should be highlighted in order to improve patients’ management and living.
Disclosure of Interest None Declared
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