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Common mental disorders within chronic inflammatory disorders: a primary care database prospective investigation
  1. Alexandru Dregan1,
  2. Faith Matcham1,
  3. Lisa Harber-Aschan2,
  4. Lauren Rayner1,
  5. Anamaria Brailean1,
  6. Katrina Davis1,
  7. Stephani Hatch1,
  8. Carmine Pariante1,
  9. David Armstrong3,
  10. Robert Stewart1,4,
  11. Matthew Hotopf1,4
  1. 1 Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
  2. 2 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
  3. 3 School of Population Health & Environmental Sciences, King’s College London, London, UK
  4. 4 South London and Maudsley NHS Foundation Trust, London, UK
  1. Correspondence to Dr Alexandru Dregan, Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK; alexandru.dregan{at}


Objective There is inconsistent evidence about the association between inflammatory disorders and depression and anxiety onset in a primary care context. The study aimed to evaluate the risk of depression and anxiety within multisystem and organ-specific inflammatory disorders.

Methods This is a prospective cohort study with primary care patients from the UK Clinical Practice Research Datalink diagnosed with an inflammatory disorder between 1 January 2001 and 31 December 2016. These patients were matched on age, gender, practice and index date with patients without an inflammatory disorder. The study exposures were seven chronic inflammatory disorders. Clinical diagnosis of depression and anxiety represented the outcome measures of interest.

Results Among 538 707 participants, the incidence of depression ranged from 14 per 1000 person-years (severe psoriasis) to 9 per 1000 person-years (systemic vasculitis), substantively higher compared with their comparison group (5–7 per 1000 person-years). HRs of multiple depression and anxiety events were 16% higher within inflammatory disorders (HR, 1.16, 95% CI 1.12 to 1.21, p<0.001) compared with the matched comparison group. The incidence of depression and anxiety was strongly associated with the age at inflammatory disorder onset. The overall HR estimate for depression was 1.90 (95% CI 1.66 to 2.17, p<0.001) within early-onset disorder (<40 years of age) and 0.93 (95% CI 0.90 to 1.09, p=0.80) within late-onset disorder (≥60 years of age).

Conclusions Primary care patients with inflammatory disorders have elevated rates of depression and anxiety incidence, particularly those patients with early-onset inflammatory disorders. This finding may reflect the impact of the underlying disease on patients’ quality of life, although the precise mechanisms require further investigation.

  • autoimmune diseases
  • epidemiology
  • inflammation
  • mental health
  • primary care

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  • Handling editor Josef S Smolen

  • Contributors AD, FM, AB, KD, CP, DA, RS, SH and MH were responsible for study design. AD was responsible for data acquisition. AD analysed the data and wrote the manuscript. All authors critically revised the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Independent Scientific Advisory Committee (reference no 17_036RA).

  • Provenance and peer review Not commissioned; externally peer reviewed.