{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T13:20:28Z","timestamp":1780579228854,"version":"3.54.1"},"reference-count":85,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2023,5,8]],"date-time":"2023-05-08T00:00:00Z","timestamp":1683504000000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,4,18]]},"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the association between anxiety, depression and resilience with overall health and functioning in axial spondyloarthritis (axSpA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional evaluation of baseline data from a prospective cohort study, with recruitment from January 2018 to March 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Outpatient clinic in a tertiary hospital in Singapore.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Patients aged 21 years and above who were diagnosed with axSpA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>The Hospital Anxiety and Depression Scale (HADS) was used for assessing anxiety and depression, 10-item Connor Davidson Resilience Scale (CD-RISC-10) for resilience, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for disease activity, Bath Ankylosing Spondylitis Functional Index (BASFI) for functional limitation and Assessment of SpondyloArthritis International Society Health Index (ASAS HI) for overall health and functioning. Univariable and multivariable linear regression analyses were performed to assess the association between anxiety, depression and resilience with health and functioning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 296 patients in this study. The median (IQR) score for HADS-Anxiety was 5.0 (2.0\u20138.0), with 13.5% and 13.9% having borderline abnormal and abnormal anxiety, respectively. The median (IQR) score for HADS-Depression was 3.0 (1.0\u20137.0), with 12.8% and 8.4% having borderline abnormal and abnormal depression, respectively. The median (IQR) CD-RISC-10 score was 29.0 (23.0\u201332.0) while the median (IQR) ASAS HI score was 4.0 (2.0\u20137.0). Apart from BASDAI, BASFI and disease duration, anxiety and depression were associated with overall health and functioning (\u03b2: 0.12, 95%\u2009CI 0.03, 0.20; \u03b2: 0.20, 95%\u2009CI 0.09, 0.31) in the multivariable linear regression. Level of resilience was not associated with health and functioning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Anxiety and depression, but not resilience, were associated with poorer health and functioning. Clinicians could consider routinely screening for anxiety and depression in their patients, especially in patients with more severe symptoms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-071944","type":"journal-article","created":{"date-parts":[[2023,5,8]],"date-time":"2023-05-08T12:30:51Z","timestamp":1683549051000},"page":"e071944","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Association of anxiety, depression and resilience with overall health and functioning in axial spondyloarthritis (axSpA): a cross-sectional study"],"prefix":"10.1136","volume":"13","author":[{"given":"Deborah Xin Yi","family":"Chung","sequence":"first","affiliation":[{"name":"Department of Medicine, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying Ern","family":"Loo","sequence":"additional","affiliation":[{"name":"Department of Medicine, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7802-9696","authenticated-orcid":false,"given":"Yu Heng","family":"Kwan","sequence":"additional","affiliation":[{"name":"Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore"},{"name":"Department of Rheumatology and Immunology, Singapore General Hospital, Singapore"},{"name":"Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1357-8568","authenticated-orcid":false,"given":"Jie Kie","family":"Phang","sequence":"additional","affiliation":[{"name":"Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2433-5572","authenticated-orcid":false,"given":"Ting Hui","family":"Woon","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei Rui","family":"Goh","sequence":"additional","affiliation":[{"name":"Department of General Medicine (Rheumatology), Sengkang General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley","family":"Angkodjojo","sequence":"additional","affiliation":[{"name":"Department of General Medicine (Rheumatology), Sengkang General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1891-1892","authenticated-orcid":false,"given":"Warren","family":"Fong","sequence":"additional","affiliation":[{"name":"Department of Medicine, National University of Singapore, Singapore"},{"name":"Department of Rheumatology and Immunology, Singapore General Hospital, Singapore"},{"name":"Duke-NUS Medical School, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,5,8]]},"reference":[{"key":"2025121406531648000_13.5.e071944.1","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1097\/RHU.0000000000000589","article-title":"Patient burden of axial spondyloarthritis","volume":"23","author":"Strand","year":"2017","journal-title":"J Clin Rheumatol"},{"key":"2025121406531648000_13.5.e071944.2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-203967"},{"key":"2025121406531648000_13.5.e071944.3","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2021-001681","article-title":"Sex-associated and gender-associated differences in the diagnosis and management of axial spondyloarthritis: addressing the unmet needs of female patients","volume":"7","author":"Chimenti","year":"2021","journal-title":"RMD Open"},{"key":"2025121406531648000_13.5.e071944.4","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1016\/j.semarthrit.2021.07.021","article-title":"The ASAS-OMERACT core domain set for axial spondyloarthritis","volume":"51","author":"Navarro-Comp\u00e1n","year":"2021","journal-title":"Semin Arthritis Rheum"},{"issue":"5 Suppl 85","key":"2025121406531648000_13.5.e071944.5","first-page":"S105","article-title":"The asas health index (asas HI)-a new tool to assess the health status of patients with spondyloarthritis","volume":"32","author":"Kiltz","year":"2014","journal-title":"Clin Exp Rheumatol"},{"key":"2025121406531648000_13.5.e071944.6","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.104117"},{"key":"2025121406531648000_13.5.e071944.7","unstructured":"International classification of functioning, disability and health (ICF). 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