Ankylosing spondylitis (AS) is a chronic inflammatory form of arthritis that primarily affects the spine and sacroiliac joints, causing pain, stiffness, and, over time, reduced flexibility as vertebrae can fuse together. It typically begins in the late teens to early thirties, follows a lifelong course of flares and remission, and falls under the broader umbrella of axial spondyloarthritis.
A 2025 study published in Advances in Rheumatology, drawing on a large patient registry in China, found that psychological disorders are common among people with AS — and that how active the disease is on any given day matters far more than a person's age or sex in predicting who struggles most.
What the Research Shows
Researchers surveyed 378 people with ankylosing spondylitis using the DASS-21, a validated 21-item scale measuring depression, anxiety, and stress. Overall, 26.72% of patients — more than 1 in 4 — had at least one diagnosable psychological disorder: 17.5% had depression, 21.1% had anxiety, and 7.9% had stress. Strikingly, among those with any psychological disorder, 53.47% had more than one of these conditions overlapping at the same time, showing how tightly depression, anxiety, and stress can become intertwined in AS. Disease activity was the single biggest driver of risk: people with active disease had over three times the odds of any psychological disorder (OR=3.04), more than four times the rate of anxiety, and over three-and-a-half times the rate of stress compared with people whose disease was inactive. A poorer overall health index, greater fatigue, and a person's own lower self-rating of their condition were also significant risk factors — notably, a person's age and sex were not.
Ways to Cope With Ankylosing Spondylitis
- Track disease activity and mood side by side. Because active flares are so strongly linked to psychological strain, noticing when your AS is flaring can help you anticipate rougher emotional patches and plan extra support in advance.
- Take fatigue seriously as a treatment target, not just an inconvenience. Fatigue was one of the strongest individual predictors of depression in this research, so addressing it with your care team, through pacing, sleep, or medication adjustments, may also help protect your mood.
- Watch for more than one struggle at once. Because over half of people with a psychological disorder in this study had more than one overlapping, don't assume that treating anxiety alone will resolve low mood, or vice versa — mention all your symptoms to your provider.
- Ask about a rheumatology team that treats the whole picture. A specialist who monitors disease activity closely and takes your own self-assessment seriously can catch both physical flares and emotional strain earlier.
- Don't wait for a crisis to seek support. With over a quarter of patients affected, psychological difficulty in AS is common and expected, not a personal failing, and it deserves proactive, dedicated attention alongside physical treatment.
Estimates Vary, But the Pattern Is Consistent
A systematic review of 17 separate cross-sectional studies found AS depression rates ranging widely, from as low as 4.9% to as high as 55.5%, depending on the population studied and the tool used to measure it. The large registry study above, using a standardized 378-patient sample and a validated instrument, landed toward the lower-middle of that range at 17.5%. This kind of variation is common in chronic illness research and doesn't mean the risk isn't real — it means the exact numbers depend on who is studied and how, while the underlying pattern, that disease activity substantially raises psychological risk, shows up consistently across the research.
You Don't Have to Carry This Alone
Because ankylosing spondylitis is a lifelong autoimmune condition with unpredictable flares, many strategies that help with other ongoing illnesses apply here too — our guide to Living with Chronic Illness or Pain is a good starting point. The spinal and joint pain central to AS can be significant on its own, and our resource on Coping with Chronic Pain offers additional tools for that. Since fatigue emerged as such a strong predictor of depression in this research, our page on Long COVID, CFS/ME & Pacing offers pacing strategies that can apply broadly to fatigue from any chronic condition. And because AS is closely related to other inflammatory joint diseases, our page on Rheumatoid Arthritis and Mental Health is a natural companion resource.
Tips for Supporting Someone With Ankylosing Spondylitis
- Understand that AS is a whole-body, lifelong condition. Beyond back pain and stiffness, it can affect the eyes, digestive system, and other joints, and its unpredictable flares can disrupt plans with little warning.
- Notice when their disease seems more active. Because psychological strain rises so sharply during active disease periods, extra patience and check-ins during flares can make a real difference, even if the person doesn't ask for it directly.
- Take complaints of fatigue seriously. Fatigue in AS is not simple tiredness, and it was one of the strongest predictors of depression in this research — treat it as a real symptom deserving accommodation, not laziness.
- Don't assume a stoic exterior means everything is fine. With over a quarter of patients experiencing a diagnosable psychological disorder, and over half of those experiencing more than one, quiet struggling is common and easy to miss.
- Encourage professional mental health support without pressure. Given how common depression, anxiety, and stress are with this condition, gently normalizing therapy or counseling as a standard part of AS care, rather than a last resort, can make a real difference.