Anxiety and Depressive Symptoms in Psoriatic Arthritis: Prevalence and Associations With Sleep, Lifestyle, and Inflammatory Markers

Background: Anxiety and depressive symptoms are clinically important but frequently under-recognized comorbidities in psoriatic arthritis (PsA).We aimed to estimate the prevalence of anxiety and depressive symptoms in patients with PsA and to explore their associations with demographic, lifestyle, sleep, treatment-related, and inflammatory characteristics.Methods: This single-center analytical cross-sectional study included 110 adults receiving treatment for PsA at a specialist rheumatology clinic in Bengaluru, India.Participants completed the Hospital Anxiety and Depression Scale (HADS).Scores of 8-10 and 11-21 on either subscale were classified as borderline and abnormal, respectively; a score of at least 8 was considered screening-positive.Clinical, lifestyle, treatment, baseline erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and self-reported sleep data were obtained from the study dataset.Associations were tested using two-sided Pearson chi-square tests; exploratory paired sleep responses were assessed with the continuity-corrected McNemar chi-square test.Results: The mean age was 47.4 years (SD 13.7), and 67 participants (60.9%) were women.Twenty-nine participants screened positive for anxiety (26.4%; 95% CI 18.4-35.6),22 for depression (20.0%; 95% CI 13.0-28.7),and 18 for both (16.4%; 95% CI 10.0-24.6).Baseline sleep disturbance was significantly more frequent among participants with depressive symptoms than among those without depressive symptoms (77.3% vs. 47.7%;Pearson χ²(1)=6.18;p=0.013).Sleep disturbance was also more frequent among participants with anxiety symptoms (69.0%vs 48.1%), although this association did not reach statistical significance (Pearson χ²(1)=3.72;p=0.054).In an exploratory retrospective self-reported comparison, sleep disturbance was reported by 53.6% of participants before treatment and 1.8% after treatment (continuity-corrected McNemar χ²(1)=55.02;p<0.001); this was not a formal prospective follow-up assessment.Conclusions: Approximately one in four participants screened positive for anxiety and one in five for depression.Depressive symptoms were associated with disturbed sleep, whereas baseline ESR and CRP did not distinguish participants with and without psychological symptoms.Routine screening and multidisciplinary assessment may help identify unmet mental health needs in PsA; longitudinal studies with validated disease activity and sleep measures are required.