A study conducted by Keele University shows that patients with rheumatoid arthritis who are also suffering with anxiety or depression may avoid talking to their GP about their mental health symptoms.
Rheumatoid arthritis is a long-term inflammatory condition which causes joint pain, swelling and deformity. Although 1 in 5 people with rheumatoid arthritis experience anxiety or depression, the study (funded by the Haywood Hospital) found that healthcare providers may not recognise mental health problems; instead prioritising physical health concerns. The research showed that this negative experience of care can lead to patients feeling unable to raise their mood problems in future consultations.
The Haywood Foundation funded the set-up of nurse-led clinics in two North Staffordshire community hospitals, as part of a rheumatoid arthritis annual review. Dr Annabelle Machin, a National Institute for Health Research (NIHR) funded researcher, interviewed patients about their previous experiences of care, understanding of anxiety and depression, and preferences for the management of mood problems.
Some patients interpreted their mood problems as normal because of their rheumatoid arthritis, which prevented them from seeking help. Others reported GP appointments to be anxiety-provoking, or felt that their GP prioritised physical over mental health concerns. Patients felt these potential barriers to the discussion of their mood problems could be overcome through continuity of care, provision of time, and encouragement to attend follow-up appointments by a named GP. Patients experiencing severe anxiety and depression felt that mood problems themselves could be a barrier to self-referral for psychological therapy, suggesting that a GP referral could improve access to care.
There was key input from a patient group, who not only assisted with study design and analysis of the interview transcripts, but also helped to develop an information leaflet, which educates patients about mental health problems and treatments in rheumatoid arthritis. The leaflet is now readily available in the Patient Information and Education Resource Centre (PIER) at the Haywood Hospital.
Lead researcher and academic GP, Dr Annabelle Machin, said, "I would like to thank the NIHR for funding this study, which I hope will promote future discussion of mood problems within rheumatoid arthritis annual reviews, as this could have a great impact on both physical and mental health outcomes for patients".
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Annabelle Machin et al. Improving recognition of anxiety and depression in rheumatoid arthritis: a qualitative study in a community clinic, British Journal of General Practice (2017). DOI: 10.3399/bjgp17X691877