Perceptions of Dependence Linked to Depression Symptoms in Older Women with Osteoarthritis

Released: 7-Nov-2012 9:00 AM EST
Embargo expired: 10-Nov-2012 4:30 PM EST
Source Newsroom: American College of Rheumatology (ACR)
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Newswise — WASHINGTON – Older women with osteoarthritis who view themselves as dependent on others because they seek help to perform daily activities — such as housework — experience more sadness and depressed moods, according to new research findings presented this week at the American College of Rheumatology Annual Meeting in Washington, D.C.

Osteoarthritis, or OA as it is commonly called, is the most common joint disease affecting middle-age and older people. It is characterized by progressive damage to the joint cartilage—the cushioning material at the end of long bones. It can causes changes in the structures around the joint including fluid accumulation, bony overgrowth, and weakness of muscles and tendons, all of which may limit movement and cause pain and swelling.

Researchers based at Toronto Western Research Institute in Ontario, Canada say they were intrigued by disparities in older women’s feelings about needing help with activities due to the physical limitations caused by their OA.

“We heard some people say that when they got help from people, that made them feel independent. But other times, we heard people say that when they got help, they felt dependent,” says Monique Gignac, PhD, a senior scientist in health care and outcomes research. She and her colleagues, including epidemiologist Elizabeth Badley, PhD, wanted to find out more about why people with OA may perceive seeking help differently, and whether perceived dependence would relate to negative moods.

The researchers conducted surveys of a cross section of 209 women with OA, all 55 or older. Their questions delved into how dependent they felt when seeking help in four different areas: personal care, household activities, community mobility and valued activities. Then, they asked the participants how seeking or receiving help for these tasks made them feel, and how they perceived themselves because their OA-related disabilities caused them to seek help. The researchers did not score the participants for clinical depression; but used standardized questions to gauge mood problems and perceptions.

Results showed that on average, participants all had mild to moderate disability related to their OA, and perceived dependence. The findings showed that 28.7 percent of the women surveyed had depression scores greater than or equal to 16, indicating depressive symptomology. Greater perceived dependence was associated with greater depressive symptoms, such as feeling blue, crying often or worrying. Needing help may have had a negative impact on these women’s self-image, which then contributed to their negative mood.

The researchers suggest that needing help may have had a negative impact on these women’s self-image, which then contributed to their negative mood. “We found that if you had difficulties or activity limitations that led you to feeling dependent, you were more likely to have a depressed mood,” says Dr. Badley. “Feeling you are dependent on others, rather than independent, may give you poorer mental well-being.”

Health care professionals may use these findings to explore ways to help older OA patients perceive themselves differently when they seek help for daily activities like housework or personal care, says Dr. Gignac. “There may be a need for relabeling feelings you have about getting help. It’s up to you. You can tell yourself, ‘I’m getting help so I can get around and do the things I want to do, and isn’t that great?’ That would be an important step toward feeling better.”

Funding for this study was provided by grant 410970184 from the Social Sciences and Humanities Research Council of Canada and by the Ontario Ministry of Health, Health System-Linked grant to the Arthritis Community Research and Evaluation Unit.

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.

Editor’s Notes: Kisoo Park, MD, PhD will present this research during the ACR Annual Meeting at the Walter E. Washington Convention Center at 10:15 AM on Wednesday, November 14 in Room 204 A. Elizabeth Badley, PhD, will be available for media questions and briefing at 8:30 AM on Tuesday, November 13 in the on-site press conference room, Room 203 A-B.

Presentation Number: 2634

Physical Disability, Perceived Dependence and Depression in Older Women with Osteoarthritis

Kisoo Park (Gyeongsang National University, Jinju, South Korea)
Monique A. Gignac (Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute and University of Toronto, Toronto, Ontario)
Elizabet M. Badley (Division of Health Care and Outcomes Research, Toronto Western Research Institute; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario)

Background/Purpose: Older women with osteoarthritis (OA) often report difficulty with tasks and needing to rely on others for assistance. In addition, depressed mood has been observed among individuals with arthritis. However, there is little research examining relationship physical disability and the perception of dependence with depression among women with arthritis. This study assessed whether both physical disability and perceived dependence relate to depression or whether perceived dependence in personal care activities, household activities, community mobility and valued activities is an intermediate step in the relationship between physical disability and depressive symptoms.

Methods: Data come from a cross-sectional survey of 209 women, aged 55 or older, with osteoarthritis (OA). Physical disabilities were examined in four domains: personal care, household activities, community mobility and valued activities. Perceived dependence was asked in each domain using the question ‘Thinking about these activities, to what extent do you feel dependent?’. Responses were on a 5-point scale from 0 = ‘not at all’ to 4 = ‘a great deal’. Depression was assessed using the Center for Epidemiological Studies – Depression Scale (CES-D). Mediation analyses occurred in four step and included regression analyses as outlined by Baron and Kenny.

Results: On average, participants reported mild or moderate disability and perceived dependence. 28.7 % of participants reported a depression score ≥ 16, which indicates depressive symptomotology. The results from step 1 show that, greater difficulty with each domain of physical disabilities was significantly related to greater perceived dependence. In step 2, greater perceived dependence was significantly associated with greater depressive symptoms in all domains. Step 3 analyses showed that greater physical disabilities in each domain were significantly associated with depression. The final step testing mediation indicated that personal care activities, household activities and community mobility were fully mediated by perceived dependence. That is, once dependence was taken into account, the relationship between physical disabilities and depression was no longer significant. Partial mediation was found for dependence and valued activity limitations. Both were significantly related to depression.

Conclusion: It is important to take into account the experience of perceived dependence as a mediator in understanding the relationship between disability and depression in the domains of personal care, household, and community mobility. However, for valued activities, both disability and perceived dependence are important in understanding depression. This may be because valued activities are discretionary and reflect a person’s identity (i.e., what’s important to them). Also, they are not always activities where others can provide assistance, making perceptions of dependence less relevant. To conclude, these findings point to the importance of taking into account an individual’s reaction to their disability rather than just focusing on the severity of disability

Disclosure: K. Park, None; M. A. Gignac, None; E. M. Badley, None.


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