Anxiety symptoms and associated factors in the Scleroderma Patient-centered Intervention Network (SPIN) cohort: A cross-sectional study

Objective We (1) compared anxiety symptom levels in a multinational SSc cohort to a general population normative sample and (2) evaluated sociodemographic, lifestyle and SSc disease factors associated with symptoms. Methods Scleroderma Patient-centered Intervention Network Cohort participants completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Version 2 4a Anxiety domain upon enrolment. PROMIS domain scores use T-scores (mean = 50, S.D. = 10) calibrated to a United States normative sample. We compared T-scores to the PROMIS United States normative sample and, in SSc, assessed associations of sociodemographic, lifestyle and physician-reported disease-related variables with multivariable linear regression. Results Among 2463 participants with SSc, mean anxiety symptom T-score (52.6, S.D. = 10.0, 95% CI 52.2, 53.0) was ∼1/3 S.D. higher than the United States general population mean of 50 (S.D. = 10), though within normal limits. Higher T-scores were associated with younger age (1.07 T-score points per 10 years, 95% CI 0.74, 1.40), female sex (1.81, 95% CI 0.63, 3.00), non-married status (0.99, 95% CI 0.14, 1.84), race or ethnicity other than White (1.79, 95% CI 0.72, 2.85), living in Canada (1.70, 95% CI 0.61, 2.79), the United Kingdom (1.53, 95% CI 0.06, 2.99) or France (2.01, 95% CI 0.98, 3.03) (vs the United States), higher BMI (0.11, 95% CI 0.03, 0.17), less time since non-Raynaud's symptom onset (0.82 per 10 years, 95% CI 0.40, 1.30), gastrointestinal involvement (2.70, 95% CI 1.52, 3.88), moderate small joint contractures (1.24, 95% CI 0.10, 2.38), the absence of interstitial lung disease (0.93, 95% CI -1.79, -0.07) and Sjögren disease (1.67, 95% CI 0.17, 3.17). Interstitial lung disease was not statistically significant when accounting for an interaction with country. Anxiety was also associated with pruritus and pain intensity in a sensitivity analysis that included variables with possible bi-directional pathways with anxiety. Conclusion Anxiety symptoms were somewhat elevated among individuals with SSc and associated with multiple sociodemographic and disease factors.