Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Systemic sclerosis (SSc) is characterized by high disfigurement, morbidity, and mortality. It carries significant psychosocial impact including depression, anxiety and body image distress. However, no previous studies evaluated mental health services (MHS) utilization in SSc. Our aim was to determine the rate and source of mental healthcare for patients with SSc, and explore factors associated with MHS use.
Methods: Subjects were adult patients with SSc enrolled in the Scleroderma Patient-centered Intervention Network (SPIN) Cohort, recruited from Canada, the USA and Europe. Medical variables were provided by enrolling physicians. Subjects completed demographic variables, including questions on MHS use in the 3 months prior to enrollment, and questionnaires evaluating symptoms of depression, anxiety, fatigue, sleep disturbance, body image distress, and pain. Demographic, medical, and psychological variables were compared between patients who had used MHS and those who did not using chi-square and independent samples t-tests (or non-parametric equivalents) as appropriate. Multivariable logistic regression was then used to identify potential factors predictive of MHS use in the last 3 months.
Results: Of the included 1000 subjects, 87% were females and 57% had limited SSc. Mean age was 55.2 ± 12.1 years and mean disease duration was 11.6 ± 8.9 years. 20% used MHS in the 3 months prior to enrollment. General practitioners were the most common providers of MHS (59%), followed by psychologists (21%) and psychiatrists (13%). MHS users had shorter disease duration, more pain and were more likely to report gastrointestinal (GI) symptoms compared to non-users (Table 1). They were more likely to smoke, live in the city, be divorced and disabled, and have more symptoms of depression, anxiety, fatigue, and body image distress. Adjusting for all other factors, MHS use was associated with being on disability (odds ratio [OR] 2.50, 95% confidence interval [CI] 1.33-4.69), having shorter disease duration (OR 0.97, 95% CI 0.95-0.99), esophageal symptoms (OR 2.40, 95% CI 1.14-5.06), and higher depression (OR 1.05, 95% CI 1.00-1.10) and anxiety (OR 1.05, 95% CI 1.02-1.08) symptom scores (Table 2).
Conclusion: 20% of patients in the SPIN Cohort received mental health care in the 3 months prior to enrollment, of whom only 34% received care from a mental health specialist. Patients receiving MHS had earlier disease, more GI symptoms, higher disability, and more psychological distress. Additional studies are needed to evaluate the mental health needs of SSc patients and determine barriers to MHS use including cultural and health insurance factors.
| Table 1. Differences in demographic, medical and psychological variables between subjects who used MHS in the 3 months prior to enrollment in the SPIN Cohort and those who did not* | ||||
| Variable | Used MHS (n = 195) | Did Not Use MHS (n = 805) | p-value | |
| Age (years) | 54.1 (12.3) | 55.5 (12.1) | 0.14 | |
| Sex (female) | 169 (87%) | 701 (87%) | 0.88 | |
| Race/Ethnicity** | White | 166 (85%) | 664 (83%) | Reference |
| Black | 16 (8%) | 47 (6%) | 0.31 | |
| Other | 13 (7%) | 86 (11%) | 0.10 | |
| Marital status | Married | 113 (58%) | 536 (67%) | Reference |
| Single | 23 (12%) | 97 (12%) | 0.64 | |
| Widowed | 7 (4%) | 32 (4%) | 0.93 | |
| Divorced | 36 (18%) | 81 (10%) | < 0.01 | |
| Common Law | 16 (8%) | 52 (7%) | 0.21 | |
| Education (years) | 15.4 (3.2) | 15.1 (3.1) | 0.25 | |
| Current Occupation | Full time/part time employed | 65 (33%) | 338 (42%) | Reference |
| Unemployed | 29 (15%) | 103 (13%) | 0.13 | |
| Retired | 35 (18%) | 207 (26%) | 0.57 | |
| On disability | 34 (17%) | 55 (7%) | < 0.01 | |
| Other | 32 (16%) | 102 (13%) | 0.04 | |
| Housing location – City/urban (vs. non-city/urban) | 79 (41%) | 256 (32%) | 0.02 | |
| Smoking | 19 (10%) | 39 (5%) | 0.01 | |
| Alcohol | 99 (51%) | 394 (49%) | 0.73 | |
| Diffuse disease subset (vs. limited) | 114 (61%) | 455 (58%) | 0.36 | |
| Disease duration since first non-Raynaud’s manifestation (years) | 9.9 (8.5) | 12.0 (8.9) | < 0.01 | |
| Modified Rodnan Skin Score | 8.1 (9.4) | 8.0 (8.6) | 0.89 | |
| Gastrointestinal symptoms | Esophageal | 182 (93%) | 686 (85%) | 0.01 |
| Stomach | 75 (39%) | 229 (29%) | 0.02 | |
| Intestinal | 88 (45%) | 298 (37%) | 0.06 | |
| Interstitial lung disease | 76 (39%) | 279 (35%) | 0.41 | |
| Pulmonary arterial hypertension | 18 (9%) | 72 (9%) | 0.93 | |
| Scleroderma renal crisis | 7 (4%) | 38 (5%) | 0.48 | |
| Patient Health Questionnaire Depression Scale (PHQ-8) | 8.8 (6.0) | 5.4 (5.0) | < 0.01 | |
| Patient Reported Outcomes Measurement Information System (PROMIS-29) | Anxiety domain | 56.7 (10.1) | 50.2 (9.5) | < 0.01 |
| Fatigue domain | 60.0 (9.6) | 54.6 (11.3) | < 0.01 | |
| Sleep disturbance domain | 55.3 (7.8) | 51.9 (8.7) | < 0.01 | |
| Pain domain | 57.8 (9.4) | 55.2 (9.8) | < 0.01 | |
| Satisfaction with Appearance Scale (SWAP) | 34.8 (19.5) | 29.7 (18.8) | < 0.01 | |
| Social Interaction Anxiety Scale-6 (SIAS-6) | 3.5 (4.8) | 2.1 (3.4) | < 0.01 | |
| Cochin Hand Function Scale (CHFS-II) | 16.0 (17.6) | 13.2 (15.9) | 0.04 | |
| Scleroderma Health Assessment Questionnaire (SHAQ) | 0.9 (0.7) | 0.7 (0.7) | < 0.01 | |
| *Values are presented as number (%) for categorical variables and mean (standard deviation) for categorical variables | ||||
| **Consolidated variable accounting for the different understanding of race and ethnicity in different parts of the world | ||||
| Table 2. Results from multivariable logistic regression analysis reporting factors predictive for mental health services utilization in the 3 months prior to enrollment in the SPIN cohort | |||
| Variable | Adjusted Odds Ratio (95% Confidence Interval) | p-value | |
| Age | 1.01 (0.99 – 1.03) | 0.58 | |
| Male sex (vs. female) | 0.86 (0.48 – 1.54) | 0.62 | |
| Education | 1.03 (0.97 – 1.09) | 0.35 | |
| Marital status | Married | Reference | |
| Single | 0.72 (0.36 – 1.43) | 0.35 | |
| Widowed | 2.07 (0.81 – 5.31) | 0.13 | |
| Divorced | 1.68 (0.97 – 2.89) | 0.06 | |
| Common Law | 0.97 (0.46 – 2.03) | 0.93 | |
| Current Occupation | Full time/part time employed | Reference | |
| Unemployed | 1.22 (0.67 – 2.24) | 0.51 | |
| Retired | 0.90 (0.50 – 1.62) | 0.72 | |
| On Disability | 2.50 (1.33 – 4.69) | < 0.01 | |
| Other | 1.69 (0.96 – 3.00) | 0.07 | |
| Diffuse disease (vs. limited) | 0.76 (0.50 – 1.15) | 0.19 | |
| Disease duration | 0.97 (0.95 – 0.99) | 0.01 | |
| Gastrointestinal symptoms | Esophageal | 2.40 (1.14 – 5.06) | 0.02 |
| Stomach | 1.21 (0.79 – 1.86) | 0.38 | |
| Intestinal | 0.83 (0.54 – 1.27) | 0.39 | |
| PHQ-8 | 1.05 (1.00 – 1.10) | 0.04 | |
| PROMIS-29 – Anxiety domain | 1.05 (1.02 – 1.08) | < 0.01 | |
| SWAP | 1.00 (0.98 – 1.01) | 0.69 | |
| SHAQ | 0.86 (0.62 – 1.20) | 0.38 | |
To cite this abstract in AMA style:
Becetti K, Gordon JK, Nguyen J, Mancuso C, Kwakkenbos L, Carrier ME, Thombs BD, Spiera RF. Mental Health Care in Systemic Sclerosis; Rates of Utilization and Associated Factors in the Scleroderma Patient-Centered Intervention Network Cohort [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/mental-health-care-in-systemic-sclerosis-rates-of-utilization-and-associated-factors-in-the-scleroderma-patient-centered-intervention-network-cohort/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/mental-health-care-in-systemic-sclerosis-rates-of-utilization-and-associated-factors-in-the-scleroderma-patient-centered-intervention-network-cohort/