In Systemic Sclerosis, Anxiety and Depression, Assessed By Hospital Anxiety And Depression Scale Are Independently Associated With Disability And Psychological Factors

Background. Anxious and depressive symptoms are frequent in Systemic Sclerosis
(SSc). Our aim is to assess their prevalence, their association with district
and global disability and psychological variables and potential differences between
subsets.
Methods. 119 SSc patients (14 men and 105 women; 74 with lSSc and 45 with
dSSc; age: 59.46 ± 13.87 years; disease duration, 10.74 ± 7.42 years) and 50
age- and sex-matched controls were assessed by Hospital Anxiety Depression
Scale (HADS) for anxious (HADS-A) and depressive (HADS-D) symptoms and
for comorbity of anxiety and depression. Clinical depression and anxiety were
defined for HADS score cut-off =8 or higher.
Patients were also assessed for psychological symptoms (Rosenberg Self-Esteem
Scale –RSES-, Coping Orientation to Problems Experienced-New Italian Version
-COPE-NIV-), hand (Hand Mobility In Scleroderma Test –HAMIS-, Cochin
Hand Functional Disability Scale –CHFDS-, fist closure, hand opening) and
face disability (Mouth Handicap in Systemic Sclerosis Scale-MHISS-, mouth
opening), global disability and fatigue (Health Assessment Questionnaire-HAQ-,
Functional Assessment of Chronic Illness Therapy-Fatigue Scale –FACIT-).
Results. In SSc patients, HADS-D (6.14±3.97) and HADS-A (6.66±4.09) were
higher than in healthy controls (4.72±2.88 and 5.16±3.05) (p<0.05), but not different
in lSSc versus dSSc, (p= NS).
Both depression and anxiety in SSc were 36%: 15/ 119 patients (13%) had only
depression, 15/119 (13%) presented only anxiety and 28/119 (23%) had both
depression and anxiety.
Depressive patients with comorbid anxiety had significantly higher HADS-D
score than patients with depression only (11.39±1.57 vs. 9.4±1.64; p=0.001).
In controls, depression and anxiety were 10% (5/50) and 20% (10/50), lower than
in SSc (p<0.05); the co-presence of depression and anxiety, (2/50 subjects -4%-)
was lower than in SSc (p=0.001) and depressive subjects with comorbid anxiety
had significantly higher HADS-D score than those with depression only (9.5±2.1
vs. 4.92±2.86; p=0.001).
In SSc, by bivariate analysis, HADS-A and-D were positively correlated with
HAQ, HAMIS and CHFDS, MHISS, FACIT, RSES and COPE-NIV Avoidance
Strategy, and, only HADS-A, also with COPE-NIV Social Support (p<0.05 in all
cases).
By multiple regression, HADS-D was independently associated with FACIT-F
(p<0.001), RSES (p<0.001), MHISS (p=0.016), together explaining 50% of variance.
HADS-A was independently associated with RSES (p=0.006), COPE-NIV
Avoidance Strategy (p=0.003), COPE-NIV Social Support (p=0.008), FACIT-F
(p=0.022) and MHISS (p=0.029), explaining 41% of variance.
Conclusions. in SSc, depression and anxiety are frequent and correlate to local
and global disability and psychological characteristics. Depressive patients with
comorbid anxiety have higher level of depressive symptoms.