POS0507 FACTORS ASSOCIATED WITH POOR MENTAL HEALTH IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE INTERNATIONAL MAP OF AXIAL SPONDYLOARTHRITIS (IMAS)
Authors: M. Garrido-Cumbrera, V. Navarro-Compán, D. Poddubnyy, F. Sommerfleck, S. Makri, J. Correa-Fernández, S. M. Akerkar, J. Lowe, E. Karam, C. Bundy
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Impaired mental health in axial spondyloarthritis (axSpA) is associated with poorer physical outcomes and employment issues. <h3>Objectives:</h3> This study aims to assess the prevalence of poor mental health in axSpA and to identify its associated factors in a large sample of patients from the International Map of Axial Spondyloarthritis (IMAS) study from around the world. <h3>Methods:</h3> IMAS is a cross-sectional online survey (2017-2022) that includes 5,557 unselected axSpA patients worldwide from Europe, North America, Latin America, Asia, and South Africa. Mental health was evaluated by the General Health Questionnaire (GHQ-12) and patients were categorized into those with good mental health (GHQ-12 &lt;3) and those with potentially poor mental health (GHQ-12 ≥3). The independent factors evaluated were sociodemographic (age, gender, educational level, employment status and patient organization membership), lifestyles (physical activity), patient-reported outcomes (disease activity, spinal stiffness and functional limitation), disease characteristics (diagnostic delay, symptom duration and HLA-B27), anxiety and depression, extra-musculoskeletal manifestations (uveitis, inflammatory bowel disease and psoriasis) and treatments (non-steroidal anti-inflammatory drugs - NSAIDs, conventional synthetic disease-modifying antirheumatic drugs - csDMARDs and biological disease-modifying antirheumatic drugs - bDMARDs). Mann-Whitney, chi-square test and logistic regression analysis were used to evaluate relationships between the investigated factors and poor mental health (GHQ-12 ≥3) in patients with axSpA (model 1). In model 2, the analyses are replicated eliminating the factors related to mental comorbidities (anxiety and depression) in order to find possible biases in the interpretation of the results. <h3>Results:</h3> Of 5,351 patients, mean of GHQ-12 was 4.7 (median 4.0) with 59.4% potentially having poor mental health. The prevalence of poor mental health was 69.9% in South Africa, 63.7% in Latin America, 60.8% in Europe, 54.3% in North America and 51.8% in Asia (Map 1). Overall, 40.5% and 37.2% of patients experienced with anxiety and depression respectively. Patients with poor mental health were more frequently younger, females, without university education, on sick leave or unemployed, non-members of patient organizations, with less physical activity, higher level of disease activity, greater levels of spinal stiffness and functional limitations, lower symptom duration, less HLA-B27 positive, higher frequency of inflammatory bowel disease, psoriasis, anxiety, and depression. In the multivariable logistic regression, the factors associated with poor mental health were younger age (OR= 0.98, 95%CI= 0.97, 0.99), female gender (OR= 1.38, 95%CI= 1.04, 1.83), being on sick leave or unemployed (OR= 1.48, 95%CI= 1.10, 2.00), higher disease activity (OR= 1.36, 95%CI= 1.26, 1.47), greater functional limitation (OR= 1.01, 95%CI= 1.01, 1.03), presence of anxiety (OR= 2.58, 95%CI= 1.83, 3.63) and/or presence of depression (OR= 2.09, 95%CI= 1.43, 3.05; Model 1-Table 1). <h3>Conclusion:</h3> Globally, six in ten patients with axSpA had signs of mental health issues, with a higher proportion of patients with poor mental health in South Africa and a lower in Asia. Factors associated with poor mental health include domains such as younger age, female gender, employment difficulties, disease burden, and anxiety and depression diagnosis. A holistic management approach should encompass both physical and mental health in axSpA. <h3>REFERENCES:</h3> <b>NIL.</b> <b>Table 1.</b> Logistic regression analysis of demographic, socioeconomic disease-related factors with poor mental health <h3>Acknowledgements:</h3> This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study. <h3>Disclosure of Interests:</h3> Marco Garrido-Cumbrera Novartis, Victoria Navarro-Compán AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, AbbVie, Eli Lilly, Galapagos, MoonLake, MSD, Novartis, Pfizer, UCB Pharma, AbbVie, Novartis, Denis Poddubnyy AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, UCB, AbbVie, MSD, Novartis, Pfizer, Fernando Sommerfleck Abbvie, Eli Lilly, Janssen, Novartis, Abbvie, Novartis, Janssen, Souzi Makri Novartis, GSK, Bayer, José Correa-Fernández: None declared, Shashank Murlidhar Akerkar Pfizer, Novartis, Eli Lilly, Jansen, Jo Lowe No personal funding, but ASIF has received funding from Novartis, UCB, Lilly, Abbvie, Boehringer Ingleheim, Pfizer, Janssen, Elie Karam: None declared, Christine Bundy AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer.