Association between tendency towards depression and severity of rheumatoid arthritis from a national representative sample: the Medical Expenditure Panel Survey

School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA.
Current Medical Research and Opinion (Impact Factor: 2.65). 07/2010; 26(7):1685-90. DOI: 10.1185/03007991003795808
Source: PubMed


The association between RA and depression has been well documented but so far there is not much research at a national level and none using a quick classification system of RA. The purpose of this study is to further determine if this association varies by differing severity in functional status of RA patients.
This study involved a retrospective pooled cross-sectional analysis of the Household Component of Medical Expenditure Panel Survey (MEPS) for the years 2004-2006. Each year's medical conditions file was merged with the person-level consolidated file. A total of 289 individuals comprised the final adult sample of RA and related diseases. RA cases were classified into four classes of functional status according to the ACR classification criteria. Tendency towards depression was ascertained by Patient Health Questionnaire (PHQ-2) scores with scores greater than or equal to three classified as high tendency towards depression. Multivariate logistic regression with survey weights was done using SAS 9.1.
After controlling for other relevant factors, patients belonging to Class III RA were 5.92 times more likely and those belonging to Class II RA were 3.78 times more likely to have high tendency towards depression as compared to Class I RA patients. Older age groups (>or=68 years) and physical activity were other significant predictors but in a negative direction, whereas a co-morbidity index of two showed a significant positive association.
The study provides important evidence that in a nationally representative sample of US non-institutionalized civilians, there is a strong association of depression to RA and related diseases by functional severity. However, the findings should be interpreted with caution because the data does not offer any information on duration in relation to PHQ-2 scores, thus making it hard to deduce if tendency towards depression was present before the diagnosis of RA. Furthermore, disease-specific and data-specific validation of the Charlson comorbidity index has not been done which leaves the possibility of residual confounding.

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    ABSTRACT: Objectives: To determine the frequency of neuropsychiatric (NP) manifestations in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients. Patients and Methods: The study included 44 SLE and 44 RA patients. Disease activity was determined according to the SLE disease activity index and RA-28 joint score disease activity (DAS-28). NP manifestations were recorded using the ACR NP-SLE nomenclature and case definitions and neurologic rating scale was conducted using the Scripps Neurologic Rating Scale (NRS) using a 4-point scoring system. The levels of anxiety and depression were evaluated using the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D) Results: NRS identified NP manifestations in 27 SLE patients and in 31 RA patients with a total frequency of 72.5%. HAM-D scale defined 28 patients had mild, 44 patients had moderate and 16 patients had severe depression with non-significantly increased frequency of higher depression scales with RA. HAM-A scale defined 37 patients had mild, 38 patients had moderate and 13 patients had severe anxiety with non-significantly increased frequency of higher anxiety scales with RA. Numerical rating showed significantly higher HAM-D and HAM-A scores in RA patients compared to SLE patients. There was a positive significant correlation between PN evaluation scores and age, duration and severity of diseases and with feminine gender in both groups. Conclusion: NP manifestations are highly frequent among SLE and RA patients. NP examination is mandatory for evaluation of patients with collagen disease with special regard to depression and anxiety. Keywords: Systemic lupus erythematosus, rheumatoid arthritis, neuropsychiatric manifestations, anxiety, depression
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