Objectives To assess mental illness, suicidality risk and illness perceptions in people with chronic inflammatory rheumatic diseases attending the emergency department.
Methods In a cross-sectional design, out of 354 patients with diabetes, COPD and chronic inflammatory rheumatic diseases seeking urgent care at our ED during an 18-monty period. Sixty three (17.8%) had a chronic inflammatory rheumatic disease, mainly rheumatoid arthritis and spondyloarthropathies. Patients were interviewed with the MINI psychiatric interview and we also assessed the independent associations of MINI diagnosis of major depression and suicidality risk (Risk Assessment of Suicidality Scale) with illness perceptions (Brief Illness Perceptions Questionnaire) and frequency of ED use after adjusting for demographics and disease-related variables in multiple regression models.
Results The most frequently reported reasons for seeking unscheduled care were dizziness or vertigo (9.5%), back pain or pain in other parts of the body (9.5%), abdominal pain (7.9%), headache (7.9%), dyspnea (6.3%) and weakness or fatigue (6.3%). Thirty-four patients with chronic inflammatory rheumatic diseases (54.0%) had visited the ED at least once during the previous year, and 13 (20.6%) were frequent ED users (>2 ED visits the previous year). Twenty-four (38.1%) were diagnosed with any mental disorder, with 17 (27.0%) having Major Depressive Disorder and 7 (11.1%) Generalized Anxiety Disorder. Seventeen patients (27.0%) were considered suicidal according to the MINI interview. Adverse beliefs about the number of symptoms attributed to the illness (illness identity) were associated with major depression (OR=1.3, 95% CI=1.001-1.719). Suicidality risk was strongly associated with beliefs that they have lower control over the illness (personal control; b=-0.312, p=0.019). Additionally, lower comprehensibility of the disease was independently associated with increased ED use (b=-0.321, p=0.013).
Conclusions A remarkable proportion of patients with chronic inflammatory rheumatic diseases attending the emergency department present mental illnesses, mostly Major Depressive Disorder. Suicidality risk is also present in approximately one third of patients with chronic inflammatory rheumatic diseases attending the ED, and it is associated with adverse illness perceptions about personal illness control. Early recognition and treatment of mental illness, psycho-educational strategies targeting disease-related cognitions and information provision regarding the disease's symptoms and treatment may prove effective in reducing unscheduled or urgent health-care use in people with chronic inflammatory rheumatic diseases.
Acknowledgements This research (ARISTEIA-ABREVIATE) has been co-financed by the European Union (European Social Fund - ESF) and Greek national funds through the Operational Program “Education and Lifelong Learning” of the National Strategic Reference Framework (NSRF) - Research Funding Program: ARISTEIA; “Investing in knowledge society through the European Social Fund”.
Disclosure of Interest None declared
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