Contextual, Disease-Related Factors Linked to Depressive Symptoms in Ankylosing Spondylitis

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Researchers aimed to identify factors related to depressive symptoms in ankylosing spondylitis and comprehend their underlying associations.

Among patients with ankylosing spondylitis (AS), contextual and disease-related factors are associated with depressive symptoms, according to study results published in Arthritis Research & Therapy.

The study included patients with AS (n=245) aged ≥18 years from 6 hospitals in the Netherlands who fulfilled the modified New York criteria for AS. Researchers used the Hospital Anxiety and Depression Subscale (HADS-D) to assess depressive symptoms and collected data on contextual and disease-related factors. Using structural equation modeling, they explored direct and indirect associations between risk factors and latent depressive symptom outcome, and selected a final model according to the model fit criteria and clinical plausibility.

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Of 245 patients, 44 (18%) had an HADS-D score ≥8 (median score, 3), indicating possible depression.

In the final model, the researchers found that contextual factors, including being men and employed, having lower income, lower mastery, and worse satisfaction with social role participation, were all significantly associated with depressive symptoms.

The only disease-related factor associated with depressive symptoms was the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), which acted only indirectly by mastery. However, the standardized total effect of BASDAI was smaller than that of several contextual factors.

Researchers noted that mastery had a central role in the path diagram, mediating the effects of BASDAI, income, and satisfaction with social role participation on depressive symptoms.

The final model was able to account for 64% of the variance in the depression outcome.

Study limitations included its cross-sectional design, and the fact that abnormal HADS-D scores did not necessarily denote a diagnosis of major depressive disorder.

“Timely diagnosis and management of depression in AS will improve patients’ health and likely save societal costs,” the researchers wrote.

Disclosure: This clinical trial was supported by AbbVie Inc. Please see the original reference for a full list of authors’ disclosures.


Webers C, Vanhoof L, Leue C, Boonen A, Köhler, S. Depression in ankylosing spondylitis and the role of disease-related and contextual factors: a cross-sectional study. Arthritis Res Ther. 2019;21(1):215.