How Chronic Immune Conditions And Mental Health Are Linked

There are a growing number of Canadians who are affected by chronic immune-mediated inflammatory diseases¹,² and mental health plays a significant role for people dealing with these conditions.³

Updated August 8, 2023

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There are approximately seven million Canadians who live with chronic immune diseases[2] who may not be aware of the significant mental health challenges they could face. Conditions like psoriasis, inflammatory bowel diseases (IBD), psoriatic arthritis and rheumatoid arthritis are all chronic immune-mediated inflammatory diseases (IMIDs). They can be debilitating for those who live with them and the physical symptoms can feel all-consuming[4], but what about the unseen side of managing a chronic condition? What are chronic immunological conditions? Immune-mediated inflammatory diseases are a group of chronic conditions with vastly different symptoms, rooted in damage caused by inflammation in the body[5]. They are often characterized by their unpredictable nature—people living with these conditions will experience episodes, also known as flare-ups, that can be brought on or amplified by stress[6][7]. While these conditions are physically different from one another, what they share is their sometimes-profound impact on quality of life. What’s the connection between physical symptoms and mental health? People who manage IMIDs have to juggle irregular or inconsistent symptoms, some of which can be physically obvious, and some invisible[6]. When people living with psoriasis are managing a flare-up, they might feel self-conscious about how it looks, meeting new people, or connecting intimately with a partner[8]. When an individual with rheumatoid arthritis experiences pain with mobility, it can cause difficulty for everyday tasks[9], like getting out of bed, and can significantly impact their ability to maintain a consistent routine for their social and professional lives[10]. People with IBD can experience sudden, painful and unpredictable bowel movements and constantly have to consider access to washroom facilities, and might have to carry an emergency kit with a change of clothes when on the go[11][12]. The mental health connection is even less obvious:

Depression is experienced by an estimated 25 to 50 percent of people who live with a chronic disease[13]
Abnormal levels of anxiety are found in 40 percent of patients with IBD[14]
People with arthritis are 2 to 10 times more likely to have mental health issues versus general population rates[15]
In a recent study, almost 70 percent of people with psoriasis felt their illness contributed to lack of self-esteem[16]

Antonella Scali, Executive Director at Canadian Psoriasis Network, has seen firsthand the many mental health challenges faced by those living with psoriasis on a daily basis. “The burden of mental health issues for people with psoriasis can be significant—our recent survey findings confirm this with 63 percent of those managing psoriasis citing their disease worsened their overall quality of life, with over one-third saying they have anxiety and/or depression,” she says. Continuing, Antonella shared that “with psoriasis being a life-long, chronic illness, mental health support is needed throughout the entire lifespan. We need to arm people with tools to manage both mental and physical symptoms as they undeniably go to together.” Whether it’s hesitation to disclose an IBD diagnosis to colleagues in fear of judgement, or society perceiving someone experiencing a psoriasis flareup as contagious, people who have chronic immune-mediated conditions face stigma far too often. In fact, a study found that 84 percent of survey respondents who have psoriasis indicated facing psoriasis-related discrimination and/or humiliation[17]. “A diagnosis of a chronic health condition can most definitely impact your mental health, as this comes with the understanding that you will be experiencing symptoms long term—sometimes for your entire life,” said Dave Gallson, National Executive Director, Mood Disorders Society of Canada. “It’s important for anyone dealing with this type of diagnosis to know that managing your mental health is equally as important as managing physical symptoms. There are resources and help available, and you do not have to suffer alone or in silence.” Where can I find help? Patient organizations and support groups are a great place to start if you’re looking for support, or to learn more about immunological conditions.

Canadian Psoriasis Network provides helpful information on psoriasis and psoriatic arthritis, access to webinars, as well as educational resources.
Take a Pain Check provides support for youth and young adults with rheumatic disease. Through social media initiatives, advocacy, and raising awareness, the site provides resources and a community for young adults navigating rheumatoid arthritis.
Crohn’s and Colitis Canada has resources for those who would like to learn about the diseases, information on managing them, and even a “GoHere Washroom Access Program.”
Mood Disorders Society of Canada provides access to a variety of online resources including information on how to navigate depression and/or anxiety, as well as support for families who are dealing with a loved one who is experiencing mental illness.

Acknowledging and addressing mental health concerns is a crucial aspect of managing your overall health, and it’s important to understand the relationship between physical and mental symptoms to know how to find help when you need it. Individuals suffering from an immunological condition should consult with their healthcare provider about any questions or symptoms they are experiencing related to their condition.

[1] Government of Canada CIof HR. Inflammation in chronic disease – featured researchers. Published February 18, 2019. Accessed May 5, 2023. CIHR. https://cihr-irsc.gc.ca/e/49032.html.

[2] Communications C. Inflammatory conditions affect more than 7 million Canadians. CHÉOS: Centre for Health Evaluation & Outcome Sciences. November 16, 2021. Accessed May 8, 2023. https://cheos.ubc.ca/research-in-action/inflammatory-skin-joint-and-bowel-conditions-affect-more-than-7-million-canadians/.

[3] Good Rx. Mental health and autoimmune diseases. Accessed May 5, 2023. https://www.goodrx.com/health-topic/autoimmune/mental-health-autoimmune-diseases.

[4] Harvard Health. Fatigue and autoimmune disease. Published October 14, 2022. Accessed May 5, 2023. https://www.health.harvard.edu/diseases-and-conditions/fatigue-and-autoimmune-disease#:~:text=Having%20an%20autoimmune%20disease%20can,they%20haven't%20slept%20well.

[5]Kuek A, Hazleman BL, Ostör AJ. Immune-mediated inflammatory diseases (IMIDs) and biologic therapy: a medical revolution. Postgrad Med J. 2007 Apr;83(978):251-60. doi: 10.1136/pgmj.2006.052688. PMID: 17403952; PMCID: PMC2600039. Accessed May 5, 2023

[6]Ortega MA, García-Montero C, Fraile-Martinez O, et al. Immune-Mediated Diseases from the Point of View of Psychoneuroimmunoendocrinology. Biology (Basel). 2022 Jun 28;11(7):973. doi: 10.3390/biology11070973. PMID: 36101354; PMCID: PMC9312038. Accessed May 5, 2023

[7] Damiana Chiavolini. Outbursts in autoimmunity: Disease flare-ups. Global Autoimmune Institute. https://www.autoimmuneinstitute.org/articles/about-autoimmune/autoimmune-disease-flare-ups/. Published April 11, 2023. Accessed May 5, 2023.

[8] Canadian Psoriasis Network. Life with Psoriasis. 2023. Accessed May 5, 2023. www.canadianpsoriasisnetwork.com/psoriasis-have/life/.

[9] Rheumatoid arthritis (RA): Patient journey. Accessed May 5, 2023.https://arthritis.ca/getmedia/76998ca3-ae22-4cb9-802a-68f3c6345faa/RA_Flowchart_April8_small.pdf.

[10] Arthritis Society Canada. Rheunatoid Arthritis. 2017. Accessed May 5, 2023. arthritis.ca/about-arthritis/arthritis-types-(a-z)/types/rheumatoid-arthritis.

[11] Crohn's and Colitis Canada. Travelling with IBD. 2019. Accessed May 5, 2023.crohnsandcolitis.ca/About-Crohn-s-Colitis/IBD-Journey/Travel-and-Lifestyle/What-to-Bring.

[12] Crohns And Colitis. About crohn's & colitis. What are Crohn's and Colitis? - What are Crohn's and Colitis - Crohn's and Colitis Canada. Accessed May 5, 2023. https://crohnsandcolitis.ca/About-Crohn-s-Colitis/What-are-Crohns-and-Colitis.

[13] Mental Health Commission of Canada. Mental Health & Chronic Disease. Chart. 2019. p. 1. Accessed May 5, 2023. https://doi.org/https://mentalhealthcommission.ca/wp-content/uploads/2021/11/8585-CSMC-MHCC-Chronic-Disease-Quick-Facts-EN-4p-ACC.pdf.

[14] Bannaga AS, Selinger CP. Inflammatory bowel disease and anxiety: links, risks, and challenges faced. Clin Exp Gastroenterol. 2015 Mar 23;8:111-7. doi: 10.2147/CEG.S57982. PMID: 25848313; PMCID: PMC4376063. Accessed May 5, 2023.

[15] Arthritis Foundation. "Arthritis and Mental Health." Accessed May 5, 2023. www.arthritis.org/health-wellness/healthy-living/emotional-well-being/anxiety-depression/arthritis-and-mental-health#:~:text=Rates%20of%20depression%20and%20anxiety,on%20the%20type%20of%20arth.

[16] Canadian Psoriasis Network. Psoriasis Journey to Stability – National Report. Page 11. Accessed May 5, 2023. Available at: https://www.canadianpsoriasisnetwork.com/wp-content/uploads/2018/09/JTSFinal-r.pdf.

[17] Hanlin Zhang et al., “Stigmatization in Patients with Psoriasis: A Mini Review,” Frontiers in Immunology 12 (2021). Accessed May 5, 2023. https://doi.org/10.3389/fimmu.2021.715839.

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