Mental Health Issues More Common in People with Primary Sjögren’s, Study Says

Psychiatric disorders including depression, anxiety, and sleep problems are more commonly diagnosed in people with primary Sjögren’s syndrome than in the general population or in those with another rheumatic condition, a study found.

Titled, “Increased risks of psychiatric disorders in patients with primary Sjögren’s syndrome — a secondary cohort analysis of nationwide, population-based health claim data,” the new study was published in the journal Clinical Rheumatology.

It’s fairly well-established that chronic diseases don’t just have a physical impact — they affect mental health, too. Sjögren’s syndrome is no exception; people with this disease have been shown to be at higher risk of psychiatric conditions such as depression and anxiety disorders.

However, exact rates vary based on a number of factors, such as sex and age, and these haven’t always been taken into account in previous studies.

In this new study, researchers analyzed data from the National Health Insurance Research Database of Taiwan, which holds data for the approximately 23 million people (99.9% of Taiwan’s population) who are insured by Taiwan’s single-payer health insurance program.

In the database, researchers identified 688 people diagnosed with primary Sjögren’s syndrome between 2000 and 2012. For comparison, they used 1,302 people with rheumatoid arthritis (another autoimmune disorder) and 3,440 people without a diagnosed autoimmune condition. The three groups were similar in terms of age (average about 53 years) and sex (all groups predominantly female).

The researchers looked at the incidences of five types of psychiatric conditions in these groups: depressive disorder, anxiety disorder, bipolar disorder, sleep disorder, and schizophrenia.

Overall, the incidence of these conditions was significantly higher in the Sjögren’s group (27%) than in either the arthritis group (14.1%) or the unaffected group (15.9%).

But individually, only depressive disorder, anxiety disorder, and sleep disorder occurred at significantly higher rates in the Sjögren’s group. People with Sjögren’s were about twice as likely to have any of these three conditions as people with rheumatoid arthritis or people in the third group.

The researchers then broke down these associations based on sex and age.

Anxiety disorder was more common in Sjögren’s patients regardless of sex, but depressive disorder and sleep disorder were only significantly more common in females, not males.

It should be noted that there was a relatively small number of males included in the study populations, so it’s hard to say with certainty whether this finding is reflective of a true sex-based difference. More research will be needed.

Additionally, depressive disorder — but none of the other conditions assessed — was significantly more common among Sjögren’s patients over 65 years old. This is somewhat surprising as depressive disorder usually begins, and is diagnosed, in adolescence and early-middle adulthood.

As such, the researchers suspect that this association is because of the effects Sjögren’s has on quality of life — although, of course, this study was not designed to directly prove a cause-and-effect relationship.

The researchers noted that other factors that affect mental health — marital status, education level, etc. — were not included in the database and, as such, could not be taken into account.

More research will be needed to fully understand the complex, interconnected factors that influence mental health, but this research still suggests that “clinicians should remain vigilant for symptoms or signs of these psychiatric disorders in their patients with [primary Sjögren’s syndrome],” the researchers concluded.