Background/Purpose: Clinical studies have shown high prevalence rates of mental illnesses in patients with autoimmune diseases. A recent animal study revealed that social stress induces autoimmune responses against the brain. However, whether mental illnesses are risk factors for systemic autoimmune rheumatic diseases (SARD), including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjögren’s syndrome (SS), systemic sclerosis (SSc), dermatomyositis (DM)/polymyositis (PM) are still still unknown. The Taiwanese National Health Insurance Research Database (NHIRD) provided a nationwide, population-based claim data to facilitate epidemiologic studies. Therefore, the aim of the study was to investigate the association between a history of mental illnesses and the risk of SARD using the NHIRD.

Methods: Using the 2000–2020 NHIRD, we identified 77,848 newly diagnosed SARD patients between 2002 and 2020 and selected 311,392 age-sex matched non-SARD controls at a ratio of 1:4. Mental illness was defined as having at least three ambulatory visits or one hospitalization with a diagnosis of mental illness using ICD-10-CM codes (mental and behavioral disorders: F01-F99, intentional self-harm: X60-X84, poisoning: Y10-Y19, contact with sharp objects, undetermined intent: Y28). We conducted multivariable logistic regressions to estimate the association of mental illnesses with SARDs, as well as RA, SLE, SS, SSc and DM/PM respectively, shown as adjusted odds ratios (aORs) with 95% confidence interval (CIs) after adjusting for potential confounders including age, sex, income, level of urbanization, comorbidities including diabetes mellitus, infections, renal disease, hyperthyroidism, hyperthyroidism, obesity & obesity related comorbidities, hyperlipidemia, cardiovascular disease, cerebral vascular accident, sleep apnea, gall bladder disease, osteoarthritis and gout. Sensitivity analyses were conducted by varying the definition of mental illnesses (1. use of antidepressants; 2. diagnosis of mental illnesses or use of antidepressants) or the defined exposure period of mental illnesses (1. Excluding 3 months before the index date; 2. Excluding 6 months before the index date).

Results: Fig 1 revealed the flowchart of study subjects inclusion. Table 1 compared characteristics between SARD cases and non-SARD controls. After adjusting for potential confounders, we found significant associations of between a history of mental illnesses with SARD (aOR, 1.65, 95% CI, 1.62–1.68), RA (aOR, 1.28, 95% CI, 1.24–1.32), SLE (aOR, 1.62, 95% CI, 1.54–1.71), SS (aOR, 2.35, 95% CI, 2.28–2.42), SSc (aOR, 1.40, 95% CI, 1.24–1.58) and DM/PM (aOR, 1.18, 95% CI, 1.05–1.32). As shown in Table 2, the results remained robust after using various definitions of exposure periods and various definitions of mental illnesses, except for the association between a history of mental illnesses and DM/PM.

Conclusion: This study showed that a history of mental illnesses was significantly associated with SARD as well as RA, SLE, SSc and SS. The strength of association of a history of mental illnesses with various SARDs was strongest for SS, followed by SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-between-a-history-of-mental-illness-and-the-risk-of-systemic-autoimmune-rheumatic-diseases-a-nationwide-population-based-case-control-study/