The Prevalence and Association of Depression, Anxiety and Sleep Disorders amongst Adult Rheumatoid Arthritis Patients in Saudi Arabia and its Effect on Health-related Quality of Life: A Multi-centric Cross-sectional Study
Authors: Alanazi Huda Qubayl , Alharbi Sari Abdulrahman , Alghashmari Abdulaziz Aida , Anzi Rahaf Nafei , Alawad Fatema Hani , Alhodibi Mostafa Habeeb 
Published: December 2024

Abstract

Introduction:
Rheumatoid arthritis (RA) is a chronic inflammatory disease that causes pain, stiffness and swelling in the joints. In addition to physical symptoms, RA is associated with considerable psychological burden including depression, anxiety and sleep disturbances. Previous research from Western countries has documented the high rates of co-morbid mental health conditions amongst RA patients. However, data from the Middle-eastern region remain limited. This study aimed to investigate the prevalence of depression, anxiety and sleep disorders and their association with RA among Saudi adults. It also assessed the impact of mental health symptoms on patients’ health-related quality of life (HRQoL).

Methods:
A cross-sectional design was utilised. A sample of 1584 adult RA patients from the rheumatology clinics in Saudi Arabia was recruited. Participants completed validated self-report questionnaires assessing depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), sleep quality (Pittsburgh Sleep Quality Index) and HRQoL (EQ-5D-5L). Sociodemographic and clinical information was also collected. The Chi-square tests analysed the associations between RA and mental health variables.

Results:
The sample consisted of 84.8% females, with a mean age of 34 years. Regarding clinical characteristics, 42.4% were diagnosed with RA 1–5 years ago and the mean symptom severity was 5.2. Regarding mental health, 42.4% and 72.7% reported depression symptoms including depressed mood and loss of interest, respectively. Anxiety symptoms such as excessive worry and restlessness were present in 36.4% and 60.6%, respectively. Over 63.6% experienced sleep difficulties. Significant associations were observed between RA and both depression (P < 0.001) and anxiety (P < 0.001). Mental health symptoms moderately to significantly interfere with daily functioning for 57.5%.

Discussion:
In this multi-centric cross-sectional study, researchers found in the literature review of previous studies high rates of mental health conditions; however, our research investigated the prevalence of mental health conditions and the association with RA disease. Our findings indicate significant association between RA and mental disorders, such as depression and anxiety. Finally, researchers of the study suggest to enhance the awareness level through RA patients to decrease the chance of developing mental health disorders and increase the HRQoL among RA patients.

Conclusion:
The study findings indicate a high prevalence of depression, anxiety and sleep disorders amongst adult Saudi RA patients. Strong associations were established between having RA and co-morbid depression as well as anxiety. A considerable proportion reported impaired HRQoL due to mental health symptoms. Integrating psychological screening and management into routine rheumatology care may help address the holistic needs of this patient group. Larger prospective studies are needed to provide further insight into the relationships between RA and co-morbid conditions.