Depression in rheumatoid arthritis patients: demographic, clinical, and psychological predictors

Covic, Tanya; Tyson, Graham; Spencer, David; Howe, Graydon

doi:10.1016/j.jpsychores.2005.09.011

Cited by 147 publications

(124 citation statements)

References 48 publications

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“…These results suggest that subjective measures demonstrate stronger association with psychological distress than laboratory findings or tender joints count. This is consistent with the findings of other studies [6,51].…”

Section: Ghq (Distress) T4supporting

confidence: 94%

Social support and psychological distress in rheumatoid arthritis: a 4-year prospective study

Benka

Nagyová

Rosenberger

et al. 2011

Disability and Rehabilitation

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Introduction:The objective of the study was to investigate the course of psychological distress in early rheumatoid arthritis patients and to explore the strength of its associations with disease-related variables over time. A further aim focused specifically on the associations between social support and psychological distress. Methods: The study had a longitudinal design, with four annual measurements over consecutive years. The course and stability of psychological distress on the individual level were investigated via test-retest correlation coefficients and changes over time were studied using the Friedman test for repeated measurements. Hierarchical regression analysis was performed to analyze the multilinear associations of disease activity, functional disability, joint tenderness, pain and social support with psychological distress. Results: Significant cross-sectional associations were found among functional disability, joint tenderness, pain, emotional support, instrumental support and psychological distress. However, after controlling for the erratic pattern of the disease and the relevant variables, only initial psychological distress and emotional support retained a significant relationship with psychological distress. The final regression model, in which functional disability, pain, emotional support and initial psychological distress were significant variables, explained 36% of the variance in psychological distress. Conclusion:The study stresses the importance of initial psychological distress, which was found to have the highest correlation with psychological distress experienced 4 years later. In addition, higher emotional support and lower pain were found to be the only variables independently associated with lower levels of psychological distress after controlling for the relevant variables.

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Section: Ghq (Distress) T4supporting

confidence: 94%

Social support and psychological distress in rheumatoid arthritis: a 4-year prospective study

Benka

Nagyová

Rosenberger

et al. 2011

Disability and Rehabilitation

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“…Some additional confounding factors were not possible to control for, as they were not a part of the original program in the early arthritis followup. For example, depression is common in RA 35, and there is a confirmed strong association between pain and depressive symptoms 36. Moreover, several studies have shown that depression and anxiety may impact clinical response to antirheumatic treatment 37.…”

Section: Discussionmentioning

confidence: 99%

Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate

Altawil

Saevarsdóttir

Wedrén

et al. 2016

Arthritis Care & Research

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ObjectiveTo investigate the frequency of remaining pain in early rheumatoid arthritis (RA) after 3 months of treatment with methotrexate as the only disease modifying antirheumatic drug, with a special focus on patients with a good clinical response.MethodsThe study base was cases reported to a population‐based early RA cohort who had followup data from the Swedish Rheumatology Quality Register (n = 1,241). The Disease Activity Score in 28 joints European League Against Rheumatism (EULAR) response criteria were used to evaluate clinical response to treatment as good, moderate, and no response. The primary end point was remaining pain at the 3‐months followup visit, defined as pain >20 mm on a 100‐mm visual analog scale (VAS).ResultsRemaining pain in spite of a EULAR good response at followup was associated with higher baseline disability, using the Health Assessment Questionnaire (adjusted odds ratio [OR] 2.2 [95% confidence interval (95% CI) 1.4–3.4] per unit increase), and less baseline inflammation, using the erythrocyte sedimentation rate (adjusted OR 0.81 [95% CI 0.70–0.93] per 10‐mm increase). Similar associations were detected for remaining pain at followup in spite of low inflammatory activity, defined as a C‐reactive protein level <10. Increase in VAS pain during the treatment period was observed in 19% of the whole cohort, with frequencies in the EULAR response groups of 9% (good response), 15% (moderate response), and 45% (no response).ConclusionThese results are in line with the hypothesis that a subgroup of early RA patients exhibits pain that is not inflammatory mediated, where alternative treatment strategies to traditional antiinflammatory medications need to be considered.

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“…The total CES-D score ranges from 0 to 60, a score >16 indicates a clinically relevant depression [34]. The overlaps with symptoms originating from a physical illness are limited; the CES-D has been proved to be a valid instrument in the physically ill [35], including patients with rheumatoid arthritis [36] and diabetes [37]. …”

Section: Methodsmentioning

confidence: 99%

Effects of a Multifaceted Psychiatric Intervention Targeted for the Complex Medically Ill: A Randomized Controlled Trial

Stiefel¹,

Zdrojewski²,

Hadj³

et al. 2008

Psychother Psychosom

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Background: This study evaluated a multifaceted psychiatric intervention targeted at the complex medically ill identified by means of the INTERMED, an instrument to assess case complexity. Methods: Of 885 rheumatology inpatients and diabetes outpatients who were assessed for eligibility, 247 were identified as complex (INTERMED score >20) and randomized to the intervention (n = 125, 84 rheumatology and 41 diabetes patients) or care as usual (n = 122, 78 rheumatology and 44 diabetes patients). For the majority of the cases the multifaceted intervention consisted of an intervention conducted by a psychiatric liaison nurse and/or of referral to a liaison psychiatrist, followed by advice to the treating physician or organization of a multidisciplinary case conference. Baseline and follow-up at months 3, 6, 9 and 12 measured prevalence of major depression (Mini-International Neuropsychiatric Interview), depressive symptoms (Center for Epidemiological Studies Depression Rating Scale), physical and mental health (SF-36), quality of life (EuroQol), health care utilization and HbA_1c levels (diabetic patients). Results: Prevalence of major depression was reduced from 61% (T0) to 28% (T4) in the intervention group and remained stable in care as usual (57% at T0 to 50% at T4). Compared to care as usual, significant improvement over time was observed in the intervention group with regard to depressive symptoms (F = 11.9; p = 0.001), perception of physical (F = 5.7; p = 0.018) and mental health (F = 3.9; p = 0.047) and quality of life (F = 21.8; p < 0.001). Effects tended to be stronger in diabetes patients, in patients with baseline major depression and in patients with moderate INTERMED scores. Finally, hospital admissions occurred less often in the intervention group, reaching statistical significance for the period between 6 and 9 months of follow-up (p = 0.02). Conclusions: The results suggest that a psychiatric intervention targeted for complex medical patients can improve health outcomes.

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Depression in rheumatoid arthritis patients: demographic, clinical, and psychological predictors

Cited by 147 publications

References 48 publications

Social support and psychological distress in rheumatoid arthritis: a 4-year prospective study

Social support and psychological distress in rheumatoid arthritis: a 4-year prospective study

Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate

Effects of a Multifaceted Psychiatric Intervention Targeted for the Complex Medically Ill: A Randomized Controlled Trial

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