P190 Poor mental health risk is associated with high disease activity in axial spondyloarthritis in the UK: results from the International Map of Axial Spondyloarthritis (IMAS)
Authors: Garrido-Cumbrera Marco , Christen Laura , Correa-Fernandez Jose , Hamilton Jill , Marzo-Ortega Helena 
Published: April 2023

Abstract

Background/Aims
Axial spondyloarthritis (axSpA) can have a significant impact on mental health, yet awareness of its impact remains limited among healthcare professionals, policy makers and the general public. The aim of this study was to describe mental health characteristics among UK axSpA patients and factors associated with risk of poor mental health and presence of mental health outcomes.

Methods
Data from 374 UK unselected patients from the IMAS online survey (2021) were analysed. Socio-demographic characteristics, health habits (physical activity, smoking and alcohol use), diagnostic delay, BASDAI (0-10), functional limitation (0-54), spinal stiffness (3-12), and treatment (ever or current biologics) were compared between patients with and without poor mental health outcomes (risk of poor mental health [GHQ-12 &lt;3], diagnosis of anxiety, depression, and sleep disorders) using independent Chi-square and Mann-Whitney tests. Four binary logistic regression models were used to assess variables associated with presence of specific mental health outcomes.

Results
Mean age was 56 years and 49.9% were female. 51.6% were at risk of poor mental health, among which 57.3% were female vs 42.7% male (p = 0.002). The odds ratio of being at risk of poor mental health were higher as disease activity increased (OR = 1.362) and among those who had ever used biologics (OR = 2.071). Anxiety was prevalent in 36.0% of patients, who also reported a longer diagnostic delay (13 vs 10.8 years, p = 0.023). Depression was prevalent in 35.4% of patients, and most likely observed among patient organisation members (OR = 1.743), and as disease activity increased (OR = 1.204). Longer diagnostic delay was also reported among patients diagnosed with depression (13.3 vs 10.6, p = 0.010). Lastly, sleep disorders were prevalent in 18.5% of patients and most likely among those with higher disease activity (OR = 1.416).

Conclusion
The likelihood of being at risk of poor mental health and having a diagnosis of depression and sleep disorders was significantly higher among those with greater disease activity. Interestingly, individuals at risk of depression were more likely to be members of a patient organisation, suggesting a level of awareness or need to seek information and/or support. Mental and physical health go hand in hand in axSpA, and treatment strategies should address both, especially among those with higher disease activity. Whereas patient organisations are ideally placed as gatekeepers, mental health is an area of priority for NHS services aiming to provide cost-effective care provision for long term conditions.
Disclosure
M. Garrido-Cumbrera: Grants/research support; Research support from Novartis. L. Christen: Corporate appointments; Laura Christen Employee of: Novartis Pharma AG. J. Correa-Fernandez: None. J. Hamilton: None. H. Marzo-Ortega: Consultancies; Consultancy fees from Eli Lilly, Janssen, Moonlake, Novartis, Pfizer, and UCB. Member of speakers’ bureau; Speakers bureau fees from AbbVie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Takeda and UCB. Grants/research support; Grant/research support from Janssen, Novartis and UCB.