One-Third of People With Arthritis Have Anxiety and Depression
A study shows these conditions are underdiagnosed – but treatment could help with pain and function.
A study from the Centers for Disease Control and Prevention, or CDC, found that people with arthritis have high rates of depression and anxiety, that the conditions are underdiagnosed and that many of those affected don’t receive mental health treatment – which could potentially help with their physical symptoms.
The study, published online in the journal Arthritis Care & Research, was conducted by phone with almost 1,800 people, ages 45 and older, who had been doctor-diagnosed with a form of arthritis or related condition, such as lupus or fibromyalgia. Based on their responses to a questionnaire to determine emotional well-being, 31 percent of respondents were found to have anxiety and 18 percent had depression. There was significant overlap between the two conditions: 84 percent of those with depression also had anxiety, and 50 percent of those with anxiety also had depression.
However, only half of the people with these mental health issues sought treatment for them over the past year.
The correlation between depression and arthritis, especially rheumatoid arthritis, is well known, but this study suggests anxiety may be even more common than previously believed.
Louise Murphy, PhD, lead author of the study and director of the Arthritis Program in the Division of Population Health at the CDC, says she and colleagues were surprised to find that the rates of anxiety were so high.
“If we are focusing only on depression, we are missing a whole group of people with emotional distress,” she says.
Not everyone was surprised. Michael Clark, MD, director of the chronic pain treatment program in the department of psychology and behavioral sciences at Johns Hopkins University, says this new study only adds to what is already understood by experts in the field.
“We’ve known for a long time that psychological disorders of all types are increased in patients with chronic pain disorder,” Dr. Clark says. For instance, a World Health Organization study from the early 2000s found American adults with arthritis are more likely to have a range of anxiety disorders than people without arthritis. “The bugaboo on this is, despite a crushing amount of evidence that these exist in these patient populations, they are still underdiagnosed, poorly treated and misunderstood.”
One possible reason, he says, is that “with depression and chronic pain in general, we can’t get doctors to recognize that these stand alone; they are not just due to living with chronic illness.” Many doctors believe that being depressed or anxious just comes with living with a chronic disease. Instead of looking to see if depression may be a side effect of medication or due to another stressor, some may ignore the issue.
Dr. Clark also says that mental health issues are likely underreported by patients. The stigma that persists about psychological issues may keep patients from talking about it with their doctors at all. No one wants to be labeled as “crazy,” he says. And they may not make a connection between their pain and depression.
But there is a complex relationship between mental health issues and disability, and they are strongly linked, Murphy says. Not diagnosing or treating one can impact the other greatly.
“People with mental health conditions definitely tend to have more functional limitations,” she says. Having depression may mean someone doesn’t have energy to exercise, and someone with anxiety may not work out because they are afraid to fall and make their pain worse, she adds.
According to the National Alliance on Mental Illness, or NAMI, someone who has depression and a chronic illness may be less likely to adhere to his treatment, and more likely to smoke, drink alcohol, eat poorly and neglect physical activity. All of these behaviors can all lead to poorer outcomes.
Because of the close relationship between treatment of mental health issues and improvements in pain and function, the study authors write, “Treating mental health conditions should be regarded as a fundamental part of managing arthritis symptoms.”
Antidepressants and anti-anxiety medications may help, but they aren’t the only treatment options, they write. Murphy recommends self-management classes for anxiety and depression, pointing out that a separate CDC study recently found that these classes were “associated with a considerable and sustained decrease in mental distress.”
Physical activity is another good option. Almost any kind of activity can help reduce pain and depression – and it’s essential for managing other arthritis symptoms, too. The study authors note that community-based physical activity programs, like EnhanceFitness and the Arthritis Foundation’s Walk With Ease program, are particularly good at helping people with arthritis exercise without worsening symptoms.
Murphy is hoping that simply increasing awareness of the link between arthritis and psychological issues will improve diagnosis and treatment over time.
“We’ve been aware of the physical implications, but less so of the emotional ones,” Murphy says. “There is an interaction across pain, anxiety and disability. By focusing on only one side, we are missing a whole other part of the picture.”