The relationship between benign joint hypermobility syndrome and psychological distress: a systematic review and meta-analysis

Rheumatology (Oxford). 2014 Jan;53(1):114-22. doi: 10.1093/rheumatology/ket317. Epub 2013 Sep 29.


Objective: This study examines the reported evidence of an association between benign joint hypermobility syndrome (BJHS) and psychological symptoms.

Methods: A systematic review of published (AMED, CINAHL, MEDLINE, EMBASE, PubMed, Cochrane Library) and unpublished research databases (OpenGrey, the World Health Organization (WHO) International Clinical Trials Registry Platform, Current Controlled Trials, the UK National Research Register Archive) was performed from their inception to January 2013. Studies assessing the prevalence and incidence of psychological conditions for people diagnosed with BJHS were included. Meta-analysis assessing the odds ratio (OR) and standardized mean difference in severity of psychological conditions was performed. Methodological quality was assessed using the Critical Appraisal Skills Programme (CASP) appraisal tools.

Results: Fourteen papers including 3957 participants, 1006 people with and 2951 controls without BJHS were eligible. The overall methodological quality was moderate. The results indicated that people with BJHS experience significantly greater perceptions of fear and more intense fear (P < 0.05) and have a higher probability of demonstrating agoraphobia (P < 0.05), anxiety (OR 4.39, 95% CI 1.92, 10.40), depression (OR 4.10, 95% CI 1.79, 9.41) and panic disorders (OR 6.72, 95% CI 2.22, 20.35) than those without BJHS (P ≤ 0.005). Neither anxiety nor depression have been assessed in childhood populations.

Conclusion: People with BJHS commonly exhibit a range of symptoms related to anxiety and depression. Considerable emotional symptoms accompany BJHS. Further study is warranted to explore how these results relate to non-Mediterranean populations and children. However, the data suggest that targeting psychological symptoms could be an important approach to managing the range of symptoms reported in these patients.

Keywords: assessment; benign joint hypermobility syndrome; mental health; panic disorder; psychological entity.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Depressive Disorder* / diagnosis
  • Depressive Disorder* / epidemiology
  • Depressive Disorder* / etiology
  • Global Health
  • Humans
  • Joint Instability* / complications
  • Joint Instability* / diagnosis
  • Joint Instability* / epidemiology
  • Mental Health*
  • Prevalence
  • Risk Assessment*
  • Syndrome