Depression Risk Factor for Mortality in Rheumatoid Arthritis; Men Most at Risk

Released: 11/7/2012 9:00 AM EST
Embargo expired: 11/10/2012 4:30 PM EST
Source Newsroom: American College of Rheumatology (ACR)
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Newswise — WASHINGTON – Depression is higher in men and women with rheumatoid arthritis, and may increase mortality in this population, according to new research findings presented this week at the American College of Rheumatology Annual Meeting in Washington, D.C.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, limitation of motion and loss of function of multiple joints. Though joints are the principal areas affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

Researchers used data collected from annual telephone surveys of 530 participants with RA who live in northern California to assess symptoms of depression and the potential impact of depression in this population. To qualify as depressed, participants must score greater than five on the Geriatric Depression Scale, a standardized measurement tool.

To be eligible, participants had to undergo an interview in either 2002 or 2003 with at least one follow-up interview. They were then followed until 2009. Participants’ mean age was 60 with a mean disease duration of 19 years, and 84 percent were female. During the study, 63 participants died. Higher depression scores were associated with mortality in the study, said Patricia Katz, PhD, investigator in the study and professor of medicine and health policy at University of California, San Francisco.

“People with rheumatoid arthritis who were depressed were more likely to die than those with RA who were not depressed. We found that seemed to be particularly true for the men. The risk of death for depressed men was twice that for depressed women,” says Dr. Katz.

Overall, men in this study had a higher mortality risk than women, after controlling for other variables. This was true for both depressed and non-depressed individuals; a baseline history of depression by the Geriatric Depression Scale resulted in approximately twice the mortality for both genders. When the increased risk associated with gender was combined with the risk associated with depression, men in the study whose scores indicated depression were five times as likely to die as women with RA whose scores indicated they were not depressed.

Men and women with increases in depressive symptoms, who may not have scored high enough on the Geriatric Depression Scale to be considered depressed, still had a higher mortality risk, says Dr. Katz. “An increase in the depressive symptom score, even if they didn’t cross over that critical line to overt depression, was still associated with a higher level of mortality.”

The study’s findings suggest that depression and depressive symptoms are a significant risk factor for mortality in RA, although it is not necessarily a part of the disease process, says Dr. Katz.

“Patients need to be made aware that depression is something to pay attention to in RA, and they need to tell their physician about it. Rheumatologists and other health care providers need to be aware of the problem of depression in the clinical setting,” Dr. Katz says.

Funding for this study was provided by the National Institute for Arthritis, Musculoskeletal, and Skin Diseases of the National Institutes of Health.

The American College of Rheumatology is an international professional medical society that represents more than 9,000 rheumatologists and rheumatology health professionals around the world. Its mission is to advance rheumatology. The ACR/ARHP Annual Meeting is the premier meeting in rheumatology. For more information about the meeting, visit www.acrannualmeeting.org or join the conversation on Twitter by using the official hashtag: #ACR2012.

Learn more about living well with rheumatic disease as well as rheumatologists and the role they play in health care. Also, discover the ACR’s Simple Tasks campaign, which highlights the severity of rheumatic diseases and the importance of early and appropriate referral to a rheumatologist.

Editor’s Notes: Patricia Katz, PhD, will present this research during the ACR Annual Meeting at the Walter E. Washington Convention Center at 5:45 PM on Sunday, November 11 in Room 140 A. Dr. Katz will be available for media questions and briefing on at 8:30 AM on Tuesday, November 13 in the on-site press conference room, Room 203 A-B.

Presentation Number: 871

Depression Predicts Mortality in RA

Christina Bode (University of Twente, Enschede, Netherlands)
Chris Tonner (University of San Francisco, San Francisco, Calif.)
Laura Trupin (University of San Francisco, San Francisco, Calif.)
Patricia P. Katz (University of San Francisco, San Francisco, Calif.)

Background/Purpose: Depression rates are elevated among individuals with rheumatoid arthritis (RA). Studies in cardiovascular disease and among elderly populations have found that depression is a risk factor for mortality, but the risk of mortality from depression in RA has received little attention.

Methods: Data were derived from a longitudinal cohort study of individuals with RA recruited from community rheumatology practices and interviewed annually by telephone. To be eligible for the current analysis, participants had to have an interview in either 2002 or 2003 and have at least one follow-up interview (n=530). Subjects were followed until 2009. Cox regression models estimated the association of depression with the risk of all-cause mortality. Depression was defined as a score ≥5 on the 15-item Geriatric Depression Scale (GDS).Using a time-dependent value, depression was defined as GDS≥5 in the last interview prior to death or censorship. In separate analyses we also examined the risk of a 2-point increase in GDS score from the penultimate to the last interview prior to death or censorship. Analyses controlled for age, gender, disease duration, and presence of any cardiovascular disease risk factors. Separate analyses also examined the conjoint effects of gender and depression.

Results: Mean age (±SD) was 60 (±13), mean disease duration was 19 (±12) years, 84% were female, and 46% reported at least one cardiovascular risk factor. Subjects were followed for a mean of 4.9 (±1.6) years until death or censorship. 63 (12%) participants died during the follow-up period. In bivariate analyses, depression was associated with an increased risk of death (HR=3.5 [95% CI 2.1, 5.8]). Worsening of GDS score by ≥2 points was also associated with an increased mortality risk (HR=2.5 [1.5, 4.2]). Controlling for covariates, both depression and an increase in GDS remained significant predictors of mortality (see Table). Interaction models showed men with depression had 5 times the risk of death compared to women with no depression. Men without depression also had a greater mortality risk than women with no depression after controlling for covariates.

Conclusion: Depression and increase in depressive symptoms are significant risk factors for all-cause mortality in RA. Men with either of these characteristics are particularly at risk. These findings provide additional evidence of the importance of identifying and treating depression among persons with RA. Strategies to motivate men for treatment of depression are especially needed.

Please visit www.rheumatology.org to view the full abstract


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