Prevalence and recognition gap of depressive and anxiety symptoms in patients with inflammatory-rheumatic diseases – a single center experience

Depression and anxiety are prevalent comorbidities in patients with inflammatory-rheumatic diseases (IRD). The presence of a mental health condition usually contributes to an increased disease burden and poorer clinical outcomes. Despite their high relevance, symptoms of depression and anxiety often remain unrecognized by physicians and therefore untreated. The aim of our study was to estimate the frequency of depressive and anxiety symptoms and the gap between self-reported symptoms and previously diagnosed psychiatric conditions. Between February and July 2024, 1000 patients at a rheumatology outpatient clinic were recruited. Pain and quality of life were rated on visual analogue scales. Routine data including diagnosis and psychiatric comorbidities were collected, along with Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores. For measurement of disease activity, disease-specific activity scores were used: Disease Activity score in 28 joints (DAS-28) for Rheumatoid Arthritis, the Bath Ankylosing Spondylitis Activity Index (BASDAI) for Spondyloarthritis and the EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI). Descriptive statistics, group comparisons and linear regression were performed to evaluate differences between disease groups. Of the 1000 patients screened, 903 predominantly female individuals (female 66.6 %, mean age 54.2 ± 14.9) with IRD were included. Mean PHQ-9 was 7.8 and GAD-7 was 5.46. Females had significantly higher mean PHQ-9 and GAD-7 scores. In between the major disease groups (joint rheumatism, connective tissue diseases, vasculitis and myositis), patients with connective tissue diseases had the highest mean PHQ-9 and GAD-7 scores. Psychological distress tended to decline with increasing age. The depression and anxiety scores were associated with DAS-28, BASDAI and ESSPRI and pain. Our findings demonstrate a high prevalence of at least mild depressive (67.7%) and anxiety (49.6%) symptoms among patients with IRD with a substantial proportion remaining undiagnosed in routine care. Mental health screenings using standardized tools such as PHQ-9 and GAD-7 may help to identify patients at risk earlier. Particular attention should be paid to women and patients with connective tissue diseases, who appear to be at a higher risk for psychological distress. • Symptoms of depression and anxiety are frequent but still underrecognized in patients with inflammatory-rheumatic diseases, highlighting a relevant gap in current clinical care. • In this large single-center study, 67% of patients reported at least mild depressive symptoms and 49.5% had at least mild anxiety symptoms, whereas only 10% had a previously diagnosed psychiatric comorbidity, indicating a substantial diagnostic gap. • Patients with connective tissue diseases and women were disproportionately affected, suggesting an even higher need for psychological support in these patient groups. • Systematic screening using PHQ-9 and GAD-7 was feasible in routine outpatient rheumatology care and identified clinically relevant symptoms beyond documented psychiatric diagnoses. • Routine mental health screening should be integrated into rheumatologic care to enable earlier identification of psychological distress and targeted support of the affected patients.