Elevated Prevalence of Concealed Mental Health Symptoms Found in Patients with Autoimmune Diseases

A recent study by the University of Cambridge and King’s College London reveals that more than half of patients diagnosed with autoimmune disorders experience mental health conditions such as depression or anxiety. Surprisingly, these symptoms are often not a routine topic of inquiry during clinical consultations. The research suggests that mental health symptoms among this patient population are more widespread and varied than previously understood, highlighting a substantial gap between what clinicians perceive and what patients actually experience.

Healthcare experts are calling for immediate intervention in the mental health care of individuals with autoimmune conditions.

According to the latest research from these academic institutions, over 50% of individuals suffering from autoimmune diseases have mental health concerns, primarily depression and anxiety. Despite these statistics, healthcare settings frequently overlook asking patients about such symptoms.

The study, which was published in the journal Rheumatology, shows that a notable number of these patients rarely or never discuss their mental health issues with healthcare professionals. Additionally, the array of possible mental and neurological symptoms extends beyond prior assumptions.

Researchers carried out a comprehensive survey that included 1,853 patients diagnosed with systemic autoimmune rheumatic diseases (SARDs), such as lupus and rheumatoid arthritis. Alongside these patients, 289 clinicians—primarily rheumatologists, psychiatrists, and neurologists—were also surveyed, and 113 interviews were conducted with both patients and clinicians.

The team examined 30 different symptoms including fatigue, hallucinations, anxiety, and depression. Among the surveyed patients, the prevalence of these symptoms was unexpectedly high. For example, 55% of SARD patients reported experiencing depression, 57% reported anxiety, 89% had severe fatigue, and 70% had cognitive dysfunction. These percentages are substantially higher than those observed in a control group comprising healthy individuals.

There is a striking contrast between clinicians’ estimates and patients’ self-reported mental health symptoms. In one case, three times as many lupus patients reported having suicidal thoughts compared to clinicians’ estimates—47% versus 15%. Medical professionals were frequently taken aback by the wide variety and frequency of symptoms reported by the patients.

The study also uncovered varying opinions among clinicians, particularly regarding the significance of mental health symptoms. Some clinicians primarily focused on joint symptoms, dismissing the possibility that SARDs could impact the brain. On the other hand, some believed these symptoms were under-acknowledged, primarily because patients were not regularly questioned about them in clinical settings.

The research further indicated that healthcare systems rarely have effective interdisciplinary collaboration involving rheumatologists, neurologists, and psychiatrists.

Dr. Tom Pollak from King’s College London emphasized the imperative nature of healthcare providers inquiring about their patients’ mental well-being. He stated that the study reveals a stark landscape of how wide-ranging and impactful these symptoms can be, urging healthcare providers to be more vigilant in addressing these issues.

Patients often hesitated to disclose their mental health conditions to clinicians, fearing stigmatization. Many stated that even when they did share their mental health symptoms, they were commonly either overlooked or improperly documented.

Dr. Melanie Sloan from the University of Cambridge described the low rate of reported symptoms as a significant concern, emphasizing the importance of actively involving patients in their healthcare journey for accurate diagnosis and treatment.

The study, funded by The Lupus Trust and LUPUS UK, concludes by recommending improved interdisciplinary collaboration between patients and clinicians to ensure equitable care in both mental and physical health.

Sarah Campbell, Chief Executive of the British Society for Rheumatology, underscored the urgency of integrating mental health support for these patients, especially considering the prevalence and impact of their neurological and psychiatric symptoms.

The Rt Hon the Lord Blunkett echoed these concerns, stating that the study underlines the necessity of increased NHS funding and holistic care for these patients, urging immediate government action.

Reference: The study, titled “Prevalence and identification of neuropsychiatric symptoms in systemic autoimmune rheumatic diseases: an international mixed methods study,” was published in the journal Rheumatology on 26 July 2023. DOI: 10.1093/rheumatology/kead369.

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