Patients of Color with Psoriatic Arthritis Report Worse Depression, Anxiety

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Patients of color with psoriatic arthritis (PsA) more frequently suffer from depression and anxiety and are more likely to report poor health-related quality of life than their White peers, according to new findings from a nationwide analysis.

In new data presented at the Congress of Clinical Rheumatology (CCR) East 2023 Annual Meeting in Destin, FL, this week, a team of Janssen-supported investigators reported that approximately 6 in 10 Black or Hispanic patients with PsA had self-reported clinical scores indicating moderate to severe depression—a rate nearly double that of White patients with PsA. The report highlights a need to better define the race- and ethnicity-specific factors of depression and anxiety in people of color managing psoriatic disease.

The team, led by Iris Lin, PhD, of Janssen Scientific Affairs, conducted an assessment of the US National Health and Wellness Survey to observe patient-reported outcomes for depression, anxiety and quality of life among patients with PsA stratified by race and ethnicity. It’s important to note that the complexity of PsA is not limited to an individual’s clinical characteristics; patients may present with unique challenges based on race and ethnicity.

“Some evidence suggests that Black, Indigenous, and People of Color (BIPOC) may develop more severe PsA and experience worse health-related quality of life than White individuals,” they wrote. “However, few studies have compared such outcomes across individual racial/ethnic groups.”

Their analysis included patients from the 2018 – 2020 iterations of the annual national health survey who self-reported a physician diagnosis of PsA. Lin and colleagues used bivariate analyses to compare patient-reported outcomes for depression and anxiety with the 9-item Patient Health Questionnaire (PHQ-9) and 7-item General Anxiety Disorder (GAD) score. They additionally interpreted health-related quality of life with the Mental Component Score (MCS), Physical Component Score (PCS), Short-Form 6 Dimension (SF-6D) Index, EuroQoL 5 Dimension (EQ-5D) Index, and EuroQoL Visual Analogue (VAS). Patients were stratified based on race and ethnicity.

Lin and colleagues included 1544 participants in their final analysis. Patients were primarily non-Hispanic White (n = 1073 [69.5%]), followed by Hispanic (n = 223 [14.4%]), then other race (n = 134 [8.7%]), then non-Hispanic Black (n = 114 [7.4%]). White patients were more likely to be older (mean age, 52.9 years); people of color were more likely to report moderate or severe PsA than White patients.

Non-Hispanic Black (57.9%) and Hispanic (60.5%) patients were significantly more likely to report moderate to severe depression per PHQ-9 scores of ≥10 than White patients (35.0%; P <.001). They were additionally more likely to report moderate to severe anxiety (39.5% and 44.4%, respectively) per GAD-7 scores of ≥10 than White patients (27.1%; P <.001).

Black and Hispanic patients additionally reported significantly worse mean MCS, SF-6D Index and EQ-5D Index scores versus White patients, indicating poorer health-related quality of life. Investigators observed insignificant differences in mean PCS and EQ-VAS scores by patient race and ethnicity.

Even with the limitation of survey participation indicating possibly higher affluence and level of education among participants versus the general PsA patient population, investigators concluded their findings show a trend of frequent depression and anxiety and worse health-related quality of live among Black and Hispanic patients than White patients with PsA.

The racial/ethnic differences observed in this study suggest a need for additional studies to better understand the factors that may influence depression, anxiety, and health-related quality of life in different racial/ethnic groups with PsA,” Lin and colleagues wrote.

References

Lin I, Krupsky K, Way N, Nelson T, et al. Racial and Ethnic Disparities in Health-Related Quality of Life in Psoriatic Arthritis: Analysis of the National Health and Wellness Survey. Paper presented at: Congress of Clinical Rheumatology (CCR) East 2023 Annual Meeting. Destin, FL. May 4 – 7, 2023.