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Original research
Impact of arthritis on the perceived need and use of mental healthcare among Canadians with mental disorders: nationally representative cross-sectional study
  1. Alyssa Howren1,2,3,
  2. J Antonio Aviña-Zubieta2,4,
  3. Deborah Da Costa5,
  4. Joseph H Puyat6,
  5. Hui Xie2,7,
  6. Mary A De Vera1,2,3
  1. 1Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Arthritis Research Canada, Richmond, British Columbia, Canada
  3. 3Collaboration for Outcomes Research and Evaluation, Vancouver, British Columbia, Canada
  4. 4Faculty of Medicine, Department of Medicine, Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada
  5. 5Faculty of Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
  6. 6Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
  7. 7Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
  1. Correspondence to Dr Mary A De Vera; mdevera{at}


Objective To evaluate the association between having arthritis and the perceived need for mental healthcare and use of mental health support among individuals with mental disorders.

Design A cross-sectional analysis using data from Canadian Community Health Survey—Mental Health (2012).

Setting The survey was administered across Canada’s 10 provinces using multistage cluster sampling.

Participants The study sample consisted of individuals reporting depression, anxiety or bipolar disorder.

Study variables and analysis The explanatory variable was self-reported doctor-diagnosed arthritis, and outcomes were perceived need for mental healthcare and use of mental health support. We computed overall and gender-stratified multivariable binomial logistic regression models adjusted for age, gender, race/ethnicity, income and geographical region.

Results Among 1774 individuals with a mental disorder in the study sample, 436 (20.4%) reported having arthritis. Arthritis was associated with increased odds of having a perceived need for mental healthcare (adjusted OR (aOR) 1.71, 95% CI 1.06 to 2.77). In the gender-stratified models, this association was increased among men (aOR 2.69, 95% CI 1.32 to 5.49) but not women (aOR 1.48, 95% CI 0.78 to 2.82). Evaluation of the association between arthritis and use of mental health support resulted in an aOR of 1.50 (95% CI 0.89 to 2.51). Individuals with arthritis tended to use medications and professional services as opposed to non-professional support.

Conclusion Comorbid arthritis among individuals with a mental disorder was associated with an increased perceived need for mental healthcare, especially in men, underscoring the importance of understanding the role of masculinity in health seeking. Assessing the mental health of patients with arthritis continues to be essential for clinical care.

  • rheumatology
  • mental health
  • epidemiology

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  • Contributors AH and MDV contributed to the study design, as well as acquisition, analysis and interpretation of data. JAA-Z, DDC, JHP and HX contributed to study design, data analysis and interpretation. AH drafted the manuscript and all study authors (AH, JAA-Z, DDC, JHP, HX and MDV) revised and approved the final version for publication.

  • Funding This work was supported by a Strategic Operating Grant from The Arthritis Society (#SOG-18-0192).Dr. De Vera holds a Canada Research Chair in Medication Adherence, Utilization, and Outcomes and is The Arthritis Society Network Scholar and Michael Smith Foundation for Health Research Scholar.Mrs. Howren is a recipient of a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship Doctoral Award and a Wayne Riggs Interdisciplinary Doctoral Scholarship in Pharmaceutical Sciences (University of British Columbia).Dr. Aviña-Zubieta is the British Columbia Lupus Society Research Scholar and the Walter & Marilyn Booth Research Scholar.Dr. Xie is Milan and Maureen Illich/Merck Frosst Chair in Biostatistics for Arthritis and Musculoskeletal Diseases.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval to use the publicly available Canadian Community Health Survey—Mental Health data was covered by University of British Columbia’s Policy (#LR9) on Research Involving Human Participants (

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. The public use microdata file can be accessed through Statistics Canada (