1022: Abuse in Rheumatic Diseases: Associations with Depression, Disability, and Psychosocial Risk Factors

Background/Purpose: Exposure to a hostile environment may negatively impact disease outcomes in patients with RD, particularly by affecting their mental health and overall quality of life. We aimed to evaluate the prevalence of abuse among patients with RD and to identify their associated factors.

Methods: We conducted a cross-sectional study at an academic rheumatology clinic, including adult patients with a clinical diagnosis of RD. A modified version of the Geriatric Mistreatment Scale was used to assess physical, psychological, neglect, economic, and sexual abuse. Psychological symptoms (DASS-21 tool), personality traits (BFI-10), functional capacity (HAQ-DI) disease activity (RAPID-3), family function (APGAR questionnaire), resilience (BRCS), and quality of life (WHOQOL-BREF) were all assessed. Patients were grouped based on reported abuse. Group comparisons were performed using X² and Mann–Whitney U tests. Univariable logistic regression was conducted to explore associations between abuse and clinical or psychosocial factors. Multivariable logistic regression was used to account for age, sex, education level, and marital status. P< 0.05 was statistically significant.

Results: We included 250 patients with RD. Median age was 52 years (IQR 44–61), and 232 (92.8%) were female. Most patients had RA (124, 49.6%), followed by SLE (50, 20.0%), and SS (20, 8.0%). The prevalence of abuse/mistreatment was 39.8% (n= 98). There were no differences in age, sex, educational level, economic status, or employment status between patients with or without abuse (Table 1).

Patients with abuse had more functional disability (34.0%) than non-abuse patients (13.2%; p< 0.001), and fewer patients with RA and abuse were on remission according to RAPID3 (46.9% vs. 65.8%, p< 0.005). Quality of life was lower among patients with abuse in the psychological, social, and environmental domains; but not in the physical domain (Table 2).

In univariable logistic regression, mistreatment was associated with higher levels of depression (OR 1.10, 95% CI 1.05–1.14), anxiety (OR 1.09, 95% CI 1.05–1.13), stress (OR 1.09, 95% CI 1.06–1.13), and disability (OR 2.10, 95% CI 1.40–3.10). It was also associated with lower quality of life (psychological, social, and environmental), higher neuroticism, and reduced coping and family function (Table 3).

After accounting for age, sex, education and marital status, abuse/mistreatment remained associated with higher levels of depression (aOR 1.10, 95% CI 1.05–1.15), anxiety (aOR 1.09, 95% CI 1.05–1.13), stress (aOR 1.10, 95% CI 1.06–1.13), and disability (aOR 2.10, 95% CI 1.40–3.10). In contrast, better quality of life (psychological, social, and environmental), along with lower neuroticism (aOR 0.83, 95% CI 0.72–0.96), adaptive coping (aOR 0.89, 95% CI 0.81–0.97), and stronger family support (aOR, 95% CI 0.67–0.87), were protective (Table 3).

Conclusion: Abuse in patients with RD is associated with greater psychological distress, disability, and disease activity, while better quality of life, coping, and family support are protective. Screening for abuse should be considered in patients care to improve outcomes.