Background/Purpose:

The United States has a deficit of rheumatology specialists. This leads to an increased burden accessing care for patients with autoimmune and connective tissue disorders requiring specialized care. Given that most rheumatologists are located in urban centers at large hospitals, many Systemic Lupus Erythematosus (SLE) patients must travel long distances for routine appointments. The present work aims to determine whether travel burden is associated with increased levels of depression and anxiety among these patients.

Methods: Data for this study were collected from the baseline visits of patients participating in two SLE studies at MUSC. At the baseline time point a travel/economic burden survey was assessed as well as the Patient Health Questionnaire 8 and the Generalized Anxiety Disorder 8 survey as measures of depression and anxiety respectively. A linear regression model was used to determine if travel burden contributes to depression/anxiety. Travel burden was determined using the “Travel Burden” questionnaire while depression/anxiety were measured using the total “Personal Health Depression Questionnaire (PHQ) 8″ or total Generalized Anxiety Disorder Screener (GAD) 8” scores. Both models adjusted for the systemic lupus activity questionnaire. Participants in these studies were largely African American women, all of whom were diagnosed with SLE.

Results:

Indicators of travel burden did not have a statistically significant association with indicators of depression and anxiety during the time frame of two weeks measured by the total Personal Health Questionnaire assessment scores. However, specifically, ‘transportation issues for medical care increasing stress’ was a statistically significantly associated with Personal Health. After adjusting for disease activity during the past three months, travel burden did have a statistically significant association with indicators of depression and anxiety. Additionally, indicators of travel burden did have a statistically significant association with indicators of depression and anxiety during the time frame of two weeks measured by the total Generalized Anxiety Disorder assessment score. However, after adjusting for disease activity during the past three months the association was no longer statistically significant.

Conclusion:

Previous studies have identified patient travel costs as being problematic. Our findings support the impact of travel burden on depression and anxiety among lupus patients. The difference in the impact of disease activity with associations of travel burden indicators, the Personal Health Questionnaire and the Generalized Anxiety Disorder assessment suggest a potentially larger role with disease activity during the past three months. Our findings suggest investigating long term disease activity to further examine the influence of travel burden. Travel burden remains a significant barrier to care for many SLE patients. Not only does inadequate access to care lead to greater direct healthcare costs but it can also result in the development or worsening of comorbid conditions. Compounding chronic conditions further complicates the treatment process for these patients and impedes appropriate resource delivery.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effect-of-travel-burden-on-depression-and-anxiety-in-african-american-women-living-with-systemic-lupus/