Sex differences evident in elevated anxiety symptoms in multiple sclerosis, inflammatory bowel disease, and rheumatoid arthritis

Jerlin Joyees; Ruth Ann Marrie; Charles N Bernstein; James M Bolton; John D Fisk; Lesley A Graff; Carol Hitchon; Scott B Patten; Kaarina Kowalec; CIHR team in defining the burden and managing the effects of psychiatric comorbidity in chronic immunoinflammatory disease

doi:10.3389/fpsyt.2023.1260420

Sex differences evident in elevated anxiety symptoms in multiple sclerosis, inflammatory bowel disease, and rheumatoid arthritis

Front Psychiatry. 2023 Nov 22:14:1260420. doi: 10.3389/fpsyt.2023.1260420. eCollection 2023.

Collaborators

CIHR team in defining the burden and managing the effects of psychiatric comorbidity in chronic immunoinflammatory disease:
Ruth Ann Marrie, Lesley Graff, John R Walker, Carol A Hitchon, Lisa M Lix, James Bolton, Jitender Sareen, Alan Katz, James J Marriott, Alexander Singer, Renée El-Gabalawy, Christine A Peschken, Ryan Zarychanski, Charles N Bernstein, John D Fisk, Scott B Patten, Lindsay I Berrigan

Affiliations

¹ College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
² Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
³ Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
⁴ IBD Clinical and Research Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
⁵ Department of Psychiatry, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
⁶ Nova Scotia Health and Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada.
⁷ Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
⁸ Section of Rheumatology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
⁹ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
¹⁰ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.

Abstract

Introduction: Immune-mediated inflammatory diseases (IMID), such as multiple sclerosis (MS), inflammatory bowel disease (IBD) or rheumatoid arthritis (RA) have high rates of elevated anxiety symptoms. This can may worsen functioning and increase IMID disease burden. The rate of and factors associated with elevated anxiety symptoms may differ between males and females, which, in turn can affect diagnosis and disease management. We evaluated whether the frequency and factors associated with comorbid elevated anxiety symptoms in those with an IMID differed by sex.

Methods: Participants with an IMID (MS, IBD or RA) completed two anxiety measures (HADS, GAD-7). We used logistic regression to investigate whether sex differences exist in the presence of comorbid elevated anxiety symptoms or in the endorsement of individual anxiety items in those with an IMID.

Results: Of 656 participants, females with an IMID were more likely to have elevated anxiety symptoms compared to males (adjusted odds ratio [aOR] 2.05; 95%CI: 1.2, 3.6). Younger age, higher depressive symptoms and income were also associated with elevated anxiety symptoms in IMID. Lower income in males with an IMID, but not females, was associated with elevated anxiety symptoms (aOR: 4.8; 95%CI: 1.5, 15.6). No other factors demonstrated a sex difference. Males had nearly twice the odds of endorsing restlessness on the GAD-7 (OR = 1.8, 95%CI: 1.07, 3.15) compared to females.

Discussion: We found evidence for sex differences in the factors associated with experiencing elevated anxiety symptoms in those with an IMID. These findings could be helpful to sensitize clinicians to monitor for comorbid anxiety symptoms in males with an IMID.

Keywords: anxiety; immune-mediated inflammatory disease; inflammatory bowel disease; multiple sclerosis; rheumatoid arthritis; sex.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was funded by the Canadian Institutes of Health Research (THC-135234), and Crohn’s and Colitis Canada. KK was supported by the University of Manitoba. RM was supported by the Waugh Family Chair in Multiple Sclerosis. CB was supported by the Bingham Chair in Gastroenterology. SP was supported by the Cuthbertson & Fischer Chair in Pediatric Mental Health.