Association between depression and rheumatoid arthritis: two longitudinal follow-up studies using a national sample cohort

Abstract

Objective To investigate the bidirectional relation between RA and depression. Methods Data from the Korean Health Insurance Review and Assessment Service – National Sample Cohort from 2002 to 2013 were analysed. Patients ≥20 years of age were included. Study I was conducted with 38 087 depression patients and 152 348 matched control participants. Study II was conducted with 7385 RA patients and 29 540 matched control participants. Stratified Cox proportional hazards models were used to analyse the hazard ratios (HRs) for depression and RA (study I) and for RA and depression (study II). The data were adjusted by the Charlson comorbidity index; rheumatic disease was excluded. Subgroups were also analysed according to age and sex. Results A total of 0.7% (1260/38 087) of the depression group and 0.6% (883/152 348) of the control I group had RA (P = 0.02). The HR for RA in the depression group was not significantly higher than that in control I group. In study II, 5.5% (408/7385) of the RA group and 4.3% (1246/29 540) of the control II group presented with depression (P < 0.001). The RA patients showed an adjusted depression HR that was 1.20 times higher (95% CI 1.07, 1.34; P = 0.002) than that of the control group. The >30-years-old and women subgroups of RA patients showed higher depression HRs than the control subgroups. Conclusion RA increased the risk of depression; however, depression did not increase the risk of RA in the Korean adult population.

Depression and Subsequent Risk for Incident Rheumatoid Arthritis Among Women

“…Our findings build on those of previous studies that also investigated depression and RA risk (25,26,37,38). A Taiwanese study investigated a bidirectional association between depression and RA using a retrospective cohort study design.…”

“…This depression risk was particularly increased in the first 2 years of follow‐up (HR 1.98 [1.43–2.15]) (25), illustrating possible reverse causation where early RA may induce depression, perhaps even before clinical diagnosis. A recent similar study using Korean administrative data found that RA increased the risk for incident depression, but the study did not detect an association of depression with incident RA risk (38).…”

“…Hazard ratios (HRs) for incident rheumatoid arthritis (RA) according to the presence or absence of depression among women in the Nurses' Health Studies (NHS) (n = 195,358), lagged by 2 questionnaire cycles (at least 4 years between depression and RA diagnosis assessments)* HR 1.98 [1.43-2.15]) (25), illustrating possible reverse causation where early RA may induce depression, perhaps even before clinical diagnosis. A recent similar study using Korean administrative data found that RA increased the risk for incident depression, but the study did not detect an association of depression with incident RA risk(38). Another retrospective cohort study investigated the association between major depressive disorder (MDD) and RA risk using The Health Improvement Network, an electronic database of general practice medical records in the UK(26).…”

Mapping publication status and exploring hotspots in a research field: Rheumatoid arthritis with depression

“…In addition, most RA cases were among people living in rural areas and the loss of labour force caused by disability further worsens the economic situation of these patients, which brings about heavy burden to their families and causes long‐term negative impact on patients. Since systematic autoimmune inflammation caused by RA can increase the risk of depression (Kim, Chanyang, Oh, & Choi, 2019), RA shares similar pathological basis with depression in the aspect of neurological–endocrine–immunological regulatory axis (Li, Y.C., Chou, Chen, Lu, & Chang, 2019; Lopresti, Maker, Hood, & Drummond, 2014; Slavich & Irwin, 2014). Unfortunately, the comorbidity of depression will further exacerbate physical disability and healthcare burden.…”

Self-care recommendations for patients with rheumatic diseases during the COVID-19 pandemic

“…can adversely affect the management and quality of life of patients with rheumatic diseases [6,7]. With a prolonged indoor life, it is necessary to reduce fear, illness, social isolation, and depression as much as possible.…”