Anxiety in patients with ankylosing spondylitis in southern-Tunisia: Level and associated factors

TL;DR

This study found that over half of ankylosing spondylitis patients in southern Tunisia experience anxiety, linked to factors like poor education, family history of chronic disease, and low quality of life.

Contribution

The study identifies specific risk factors for anxiety in ankylosing spondylitis patients in southern Tunisia, emphasizing the need for psychological screening.

Findings

54.8% of AS patients had confirmed anxiety symptoms.

Anxiety was strongly associated with poor quality of life and severe fatigue.

Educational level and family history of chronic disease were significant predictors of anxiety.

Abstract

Ankylosing spondylitis (AS) is the second most common rheumatic disease after rheumatoid arthritis. The significant functional impact of this chronic disease can affect patients’ mental health.

The aim of this study was to determine the prevalence of anxiety in subjects with AS in Southern-Tunisia and to identify its associated factors.

It was a retrospective study conducted in 2021 over a period of 5 years on patients with AS consulting the rheumatology department at the Hedi Chaker University Hospital in SFAX, Southern-Tunisia. The “Anxiety and Depression scale” was used to screen for anxiety. A score ≥11 defined confirmed anxiety symptoms.

Of the 62 patients, 35 were male (56.5%), giving a male to female ratio of 1.3. Twenty-seven patients (43.5%) were aged between 35 and 50 years. The level of education was primary in 19 cases (30.6%) and university in 15 cases (24.2%). A family history of chronic disease was present in 32 cases (51.6%). Severe fatigue was noted among 27 patients (43.5%). Quality of life was poor in 39 patients (62.9%). The mean anxiety score was 11.35±4.6. Thirty-four subjects (54.8%) had confirmed anxiety symptoms and 19 (30.5%) had borderline symptoms. Confirmed anxiety was significantly associated with the educational level (p=0.03) (illiterate: 87.5%, primary: 68.4%, secondary: 35% and university: 46.7%). Similarly, having a family history of chronic disease (OR=3.3; p=0.02), suffering from severe fatigue (OR=36, p<0.01), having associated depression (HAD score≥11) (OR=19.5; p<0.001) and having poor quality of life [Ankylosing spondylitis quality of life questionnaire (Asqol) Score ≥13] (OR=15.8; p<0.001) were statistically associated with higher prevalence of confirmed anxiety symptoms.

It was found that patients treated for AS frequently suffer from psychological co-morbidities, particularly anxiety, which can lead to a further deterioration in their quality of life and even their withdrawal from active life. Thus, anxiety should not be ignored when treating these patients.

None Declared