Anxiety, depression and quality of life in a group of rheumatic patients after joining a web-based self-help community

摘要

Introduction: Rheumatic diseases are common chronic conditions that can have a profound influence on both physical and mental health of the patients. Internet-based self-help groups are very popular among chronic patients, as a substitute of classic face-to-face self-help groups.Objective: To investigate the possibility that joining an internet-based patient group can positively affect the general and mental health of rheumatic patients.Results: We administered four different questionnaires to 34 rheumatic patients before and after joining an italian web-based self-help community. Joining the community led to a significant improvement in general health measures and in levels of anxiety and depression.Conclusions: Participating in a web-based patient community can positively affect quality of life and mental health of rheumatic patients. Introduction Rheumatic diseases are chronic conditions that can have a profound influence on the psychological status of the patient. Depression is at least two times more common in rheumatic patients than in general population 1 and it’s estimated that major depressive disorder affects between 13% and 17% of patients with rheumatoid arthritis 23. In common with other painful conditions, depression associated with rheumatoid arthritis is often considered to result from the experience of chronic pain 4, and pain have a predictive value in the risk of developing depression 5. On the opposite, depression can affect pain perception 6 and the general clinical course of the disease 7. Other factors leading to depression are degree of physical disability 8, disease activity 9, and duration of disease 10. Also anxiety have been studied in rheumatic patients. Levels of anxiety are elevated in rheumatic patients and often coexist with depression 11, infact those with rheumatoid arthritis have a 4-fold probability to suffer from anxiety disorders than control 12. Patients And Methods PatientsFor the present study 34 rheumatic patients with different diseases (RA, spondyloarthritis, SLE, other connectivitis, vasculitis) were recruited thanks to the collaboration with the italian patient association ReumAmici. This association owns a website that patients can join and therefore participate in the community activities, especially in communicating through a patient web forum. QuestionnairesFour different questionnaires exploring physical and mental health were administered to all patients at time 0 (before joining the website) and after 3 months of active and continuous participation to the community activities: SF-36, HAQ, Zung self-rated anxiety scale and Zung self-rated depression scale. All the questionnaires were submitted by email and self-reported by the patients.SF-36 questionnaire 13 was used to evaluate the Quality of Life (QoL) of the patients. This survey contains 36 questions that evaluate eight health domains in both physical health and mental health. These eight domains are physical functioning (PF, ten items), social functioning (SF, two items), role limitations caused by physical problems (RP, four items), role limitation caused by emotional problems (RE, three items), mental health (MH, five items), energy and vitality (VT, four items), pain (BP, two items), and general perception of health (GH, five items). For each item score are collected and transformed to a scale from 0 (worst possible health state) to 100 (best possible health state). The italian form of SF-36 questionnaire was used 14. HAQ questionnaire 15 was used to assess physical function of the patients. This questionnaire was developed as a comprehensive measure of outcome in patients with a wide variety of rheumatic diseases including RA, osteoarthritis, SLE, ankylosing spondylitis, fibromyalgia and psoriatic arthritis. The HAQ contains 20 items distributed across 8 components. The scores for each item range from 0 (without any difficulty) to 3 (unable to do). The highest score on any item within one component represent the dim