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.