Objectives The aim of this study was to assess the psychological well-being and to analyse factors associated with depressive symptoms in axial spondyloarthritis (axSpA). Methods A stratified random sample of subjects with a diagnosis of axSpA (International Classification of Diseases, Tenth Revision, German Modification M45) was drawn from health insurance data in Germany. These persons received a postal questionnaire on disease-related, psychological and lifestyle factors as well as socioeconomic status. Additional information to verify the axSpA diagnosis was also collected. The psychological well-being was assessed by means of the 5-item WHO Well-Being Index (WHO-5), which is considered a screening tool for depression. The following established cut-offs on the WHO-5 were applied: >50: good well-being, no depressive symptoms; 29–50: mild depressive symptoms; ≤28: moderate-to-severe depressive symptoms. Information on comorbidities, drug prescriptions and non-pharmacological treatment was retrieved from claims data and linked to the questionnaire data. Results A total of 1736 persons with a confirmed axSpA diagnosis were included. Using the cut-offs on the WHO-5, 533 persons (31%) were found to have moderate-to-severe depressive symptoms, 479 (28%) had mild depressive symptoms and 724 (42%) had a good well-being. Multivariable logistic regression revealed that higher disease activity, higher level of functional impairment, lower income, self-reported stress and lack of exercise, and younger age represent factors associated with moderate-to-severe depressive symptoms. Conclusions The prevalence of depressive symptoms in axSpA subjects is high and associated with disease-related parameters, socioeconomic status and lifestyle factors. These findings highlight the need for the careful evaluation of depressive symptoms as a part of the management strategy for axSpA.

中文翻译：

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中轴性脊柱关节炎心理健康的决定因素：基于相关索赔和患者报告调查数据的分析

目的 本研究的目的是评估中轴性脊柱关节炎 (axSpA) 的心理健康状况并分析与抑郁症状相关的因素。方法 从德国的健康保险数据中抽取诊断为 axSpA（国际疾病分类，第十次修订，德国修改 M45）的受试者的分层随机样本。这些人收到了一份关于疾病相关、心理和生活方式因素以及社会经济状况的邮寄问卷。还收集了验证 axSpA 诊断的其他信息。心理健康通过 5 项 WHO 幸福指数 (WHO-5) 进行评估，该指数被认为是抑郁症的筛查工具。应用了 WHO-5 的以下既定临界值： >50：良好的幸福感，无抑郁症状；29-50：轻度抑郁症状；≤28：中度至重度抑郁症状。从索赔数据中检索有关合并症、药物处方和非药物治疗的信息并与问卷数据相关联。结果 共纳入 1736 名确诊为 axSpA 的人。使用 WHO-5 的分界值，发现 533 人 (31%) 有中度至重度抑郁症状，479 人 (28%) 有轻度抑郁症状，724 人 (42%) 健康状况良好. 多变量逻辑回归显示，较高的疾病活动度、较高的功能障碍水平、较低的收入、自我报告的压力和缺乏运动以及年龄较小是与中度至重度抑郁症状相关的因素。结论 axSpA 受试者抑郁症状的患病率很高，并且与疾病相关参数、社会经济地位和生活方式因素有关。这些发现强调了仔细评估抑郁症状作为 axSpA 管理策略的一部分的必要性。