Arthritis and Mental Health

By Dr. Liji Thomas, MDReviewed by Dr. Jennifer Logan, MD, MPH

Arthritis is a condition associated with joint inflammation, manifesting as joint pain, swelling and stiffness, and sometimes with deformity of the joint.

Image Credit: Olena Yakobchuk/Shutterstock.com

However, many studies show that this condition is linked to mental illness. According to the Centers for Disease Control and Prevention, at least 20% of the 54 million American adults who have arthritis also suffer from anxiety or depression.

As long back as 1988, Wells et al. showed that mental disorders had occurred or would occur at some point in almost 64% of people with arthritis. About 43% of them had some form of psychiatric illness over the last 6 months. This shows that mental illness is more prevalent in this population than illnesses such as COPD, high blood pressure, cardiovascular disease or diabetes.

Other studies confirmed this finding, showing that anxiety disorders are more common in people with arthritis. Researchers say that patients with psychiatric disorders are not at a higher risk of arthritis, but instead, arthritis makes the person more prone to developing mood disorders over time.

Common symptoms of psychological ill-health

The symptoms of anxiety in these patients may include:

• Restlessness
• Lack of concentration
• Worry or irritability
• Poor sleep quality

Depressive symptoms include

• Sadness
• low self-worth
• guilt
• loss of pleasure
• physical problems such as headache, cramps, fatigue or digestive problems
• suicidal tendencies

Why are persons with arthritis more likely to experience poor mental health?

Arthritis is fundamentally a disorder of the joints, even in more systemic forms such as rheumatoid arthritis. As a result, it is associated with limitation of movement and functional impairment. The inability to do things that are valuable to the individual predisposes to the development of depression since such activities are often part of one’s identity, self-esteem, and life meaning or a source of deep pleasure.

For instance, being unable to write, for a writer, is far more than the loss of a job or financial security, important as that may be. Similarly, being unable to provide for one’s family may be the most disabling part of arthritis for a hardworking man who has been the breadwinner for decades.

The previous mental make-up of the person also contributes to the reaction to arthritic pain and disability. Individuals who believe that they are helpless or who foresee catastrophic consequences (“It’s terrible and I think it’s never going to get any better,” or “I keep thinking about how badly I want it to stop,”) are more prone to developing depression and distress.

Their mood is affected by how they perceive pain and joint symptoms. In general, such individuals feel more severe pain and disability, respond worse to pain treatment, pay more attention to their pain at the cost of other things, and are more emotionally susceptible to affective disorders like depression.

Helplessness is one belief that can keep a patient from coping well with arthritis. This is associated with passive coping instead, relying on others for all activities and avoiding doing things on one’s own because one is “helpless”, or turning to medication for pain relief.

This is associated with more disability and depression, triggering a vicious spiral downwards into mood disturbance. Active coping, on the other hand, helps patients with arthritis to adjust better to their condition both physically and emotionally.

Depression may contribute to worse outcomes following the development of arthritis because the depressed patient has more active inflammation, is functioning at a lower level, is less likely to take medication regularly, or to cooperate with treatment, leading to other illnesses. Thus, both exaggerate the effect of the other, leading to frustrations in self-management and management by healthcare providers.

In addition to the psychological explanations for the mental disorders associated with arthritis, the inflammatory cytokines, or cell signaling molecules, that are released by the body, may disrupt neurotransmission through serotonin-producing cells, causing depression.

How to prevent and cope with mental illnesses in arthritis

There are several ways in which people cope with painful conditions, including distracting oneself from the pain, ignoring the pain, praying and hoping for pain relief or the ability to bear the pain, catastrophizing, or becoming more active.

In general, individuals try to consciously cope with or suppress pain using intellectual and emotional pathways, focus on the pain and one’s hope of relief, or use substitution/distraction techniques.

Resiliency is a trait-like attribute that helps people take control of their impulses to meet the present demands, whatever they are. Resilient people are among the most capable when it comes to meeting stress positively, as they instinctively choose the appropriate coping strategy, and control themselves accordingly.

One way to learn a healthy mental attitude towards life is to take a “wellness” approach. Instead of thinking of themselves as sick and designing their day to relieve their pain and disability, such people design it around what they can do, all the ways they can enjoy life, different approaches to health including diet and exercise, and social interaction with other people. This also includes taking medication properly, learning to relieve stress, and taking time out to relax.

Avoiding crutches like alcohol or drug abuse, as well as overusing pain medications, is very important. Similarly, taking to bed and focusing on pain are counterproductive reactions. Changing such habits is hard but rewarding. It can be achieved by substituting a favorite and rewarding activity for the pain crutch, whatever it is, with the support of close friends or family, or of those who have gone down this path already. Communication with doctors is also key, to help establish control and to make use of available methods and technologies, to optimize pain control and improve the quality of life.