Background/Purpose: US population-health surveys frequently measure current mental health status using the Kessler-6 (K-6) which indicates psychological distress level. Among all US adults, moderate and serious psychological distress predict high health care utilization. Higher prevalence of serious psychological distress (SPD) among adults with arthritis compared with those without is well documented; however, little is known about moderate psychological distress (MPD) prevalence by arthritis status. We examined MPD and SPD prevalence, by arthritis status, for 2002 to 2015.

Methods: We analyzed National Health Interview Survey (NHIS) data; NHIS is an ongoing population-based survey designed to provide annual estimates representative of US civilian, non-institutionalized population. Participants had arthritis if they responded “yes” to “Have you ever been told by a doctor or other health care professional that you have arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia?”. Using the K-6, NHIS respondents rated frequency (0 [none of the time] to 4 [all of the time]) that they felt each of 6 items (sad, worthless, nervous, restless, hopeless, and everything was an effort) in the past 30 days. We categorized rating sums into 3 psychological distress levels: none-mild (0-4]; moderate (5-12); serious (≥13-24) and estimated age-standardized (2000 US projected population) prevalence and 95% confidence interval (CI). All analyses accounted for NHIS’ complex design. Moving averages were 3 year means. Tests for trend were conducted using linear orthogonal contrasts (α =0.05).

Results: MPD prevalence was 12 percentage points higher among adults with arthritis (27.4%; CI=25.2-29.7) compared with those without (15.4%; CI=14.8-16.0); SPD was also more prevalent among adults with arthritis (arthritis=8.5%; CI=7.2-10.0; without arthritis=2.6%; CI=2.3-3.0). From 2002 to 2015, only MPD increased significantly (5 percentage points) among adults with arthritis whereas both MPD and SPD prevalence increased significantly for those without arthritis (Figure).

Conclusion: In 2015, approximately 1 in 3 US adults with arthritis experienced either MPD or SPD compared with almost 1 in 5 adults without arthritis. From 2002 to 2015, SPD prevalence remained constant among adults with arthritis but MPD prevalence increased indicating that psychological distress is a growing problem. Mental health issues can reduce adherence to clinical treatment and practicing healthy behaviors. Engaging in physical activity and self-management education (e.g., Chronic Disease Self-Management Program) are proven to reduce arthritis symptoms (e.g., pain) and symptoms of mood disorders, but psychological distress may be a barrier to participation. Thus, ensuring that psychological distress is identified and addressed is an important step in helping adults with arthritis to manage their arthritis well.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/moderate-and-serious-psychological-distress-among-us-adults-with-and-without-arthritis-2002-to-2015/