Prevalence and identification of neuropsychiatric symptoms in systemic autoimmune rheumatic diseases: an international mixed methods study

Melanie Sloan, Chris Wincup, Rupert Harwood, Thomas A. Pollak, Efhalia Massou, Michael Bosley, Mervi Pitkanen, Michael S. Zandi, Guy Leschziner, Colette Barrere, Mandeep Ubhi, Laura Andreoli, James Brimicombe, Wendy Diment, David Jayne, Caroline Gordon, Felix Naughton, David D'Cruz

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


OBJECTIVE: A limited range of neuropsychiatric symptoms have been reported in systemic autoimmune rheumatic diseases (SARDs), with varied symptom prevalence. This study aimed to investigate a wider range of potential symptoms than previous studies, compare patient self-reports with clinician estimates, and explore barriers to symptom identification. METHODS: Mixed methods were used. Data from SARDs patients (n = 1853) were compared with controls (n = 463) and clinicians (n = 289). In-depth interviews (n = 113) were analysed thematically. Statistical tests compared means of survey items between patients and controls, 8 different SARD groups, and clinician specialities. RESULTS: Self-reported lifetime prevalences of all 30 neuropsychiatric symptoms investigated (including cognitive, sensorimotor and psychiatric) were significantly higher in SARDs than controls. Validated instruments assessed 55% of SARDs patients as currently having depression and 57% anxiety. Barriers to identifying neuropsychiatric symptoms included: (i) limits to knowledge, guidelines, objective tests and inter-speciality cooperation; (ii) subjectivity, invisibility and believability of symptoms; and (iii) under-eliciting, under-reporting and under-documenting. A lower proportion of clinicians (4%) reported never/rarely asking patients about mental health symptoms than the 74% of patients who reported never/rarely being asked in clinic (P < 0.001). Over 50% of SARDs patients had never/rarely reported their mental health symptoms to clinicians, a proportion underestimated at <10% by clinicians (P < 0.001). CONCLUSION: Neuropsychiatric symptom self-reported prevalences are significantly higher in SARDs than controls, and are greatly underestimated by most clinicians. Research relying on medical records and current guidelines is unlikely to accurately reflect patients' experiences of neuropsychiatric symptoms. Improved inter-speciality communication and greater patient involvement is needed in SARD care and research.

Original languageEnglish
Pages (from-to)1259-1272
Number of pages14
Issue number5
Early online date26 Jul 2023
Publication statusPublished - 2 May 2024


  • depression
  • mental health
  • neuropsychiatric
  • patient–clinician relationships
  • rheumatology
  • symptom identification
  • systemic autoimmune rheumatic diseases
  • under-reporting

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