Patient preferences for management of co-morbid anxiety and depression in rheumatoid arthritis : a qualitative study
Rheumatoid arthritis (RA) is the commonest inflammatory arthritis. Co-morbid anxiety and depression are frequent, but often under-recognised and under-treated, contributing to increased morbidity and mortality. The NICE quality standard for the management of RA (QS33) recommends that patients with RA should have a holistic annual review, including an assessment of mood. A specialist nurse-led review clinic was piloted at two community hospitals, during which patients were asked the case-finding questions for anxiety and depression (GAD2 and PHQ2).
This qualitative study aimed to explore patients’ perspectives of anxiety and depression in RA and preferences for management of mood problems. Ethical approval was obtained. A purposive sample of patients attending the annual review clinic who scored ≥3 on the case-finding questions, were invited to participate in a face-to-face interview. A topic guide was utilized. Interviews were transcribed verbatim and the transcripts formed the data which were analysed thematically using principles of constant comparison. Data saturation was reached after fourteen interviews.
From 171 patients attending the nurse-led annual review clinic, 48 (28%) scored ≥ 3 on the case-finding questions, suggesting that they were anxious and/ or depressed. Anxiety or depression were seen variably by respondents to be either related to RA or completely separate. Some perceived RA flares to be triggered by worsening mood, hence sought improved RA treatment to help manage their anxiety or depression. Participants reported self-management strategies for their mood problems such as ‘thinking positively’, keeping active or listening to music. Some perceived medication to be offered as a ‘quick-fix’ option, or expressed concerns about possible interactions with their RA medication, citing a preference for non-pharmacological treatments. Several reported problems accessing psychological therapies, recursively affecting future help-seeking, though those who had accessed ‘talking treatments’ perceived them to be helpful.
Participants cited a preference for psychological therapies, though several reported problems accessing care. Supporting self-management strategies and facilitating access to psychological therapies could improve outcomes for both mental and physical health problems.