Depression Subtypes in Individuals With or at Risk for Symptomatic Knee Osteoarthritis

Abstract

Objective. The present study was undertaken to identify depression subtypes in individuals with or at risk for symptomatic knee osteoarthritis (OA) and to evaluate differences in pain and disability trajectories between groups.Methods. Participants (n = 4,486) were enrolled in the Osteoarthritis Initiative. Latent class analysis was applied to the 20-item Center for Epidemiologic Studies Depression Scale measured at baseline to identify groups with similar patterns of depressive symptoms, and subtypes were assigned using posterior probability estimates. The relationships between depression subtypes and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and disability subscales were modeled over 4 years and stratified by baseline knee OA status (symptomatic [n = 1,626] or at risk [n = 2,860]).Results. Four subtypes were identified: asymptomatic (80.6%), catatonic (5.3%), anhedonic (10.6%), and melancholic (3.5%). Catatonic and anhedonic subtypes were differentiated by symptoms corresponding to psychomotor agitation and the inability to experience pleasure, respectively. The melancholic subtype expressed symptoms related to reduced energy and movement, anhedonia, and other somatic symptoms. Detectable mean differences in pain and disability compared to the asymptomatic group were observed for the anhedonic (1.5-2.3 WOMAC units) and melancholic (4.8-6.6 WOMAC units) subtypes, and associations were generally larger in individuals with symptomatic knee OA relative to those at risk.Conclusion. Among individuals with or at risk for symptomatic knee OA, there is evidence of depression subtypes characterized by distinct clusters of depressive symptoms that have differential effects on reports of pain and disability over time. Our findings thus imply that depression interventions could be optimized by targeting the specific symptomology that these subtypes exhibit.

The relationship between mental health/physical activity and pain/dysfunction in working-age patients with knee osteoarthritis being considered for total knee arthroplasty: a retrospective study

“…An interesting recent study on individuals with or at risk for symptomatic KOA identified the following four subtypes of depression: asymptomatic, catatonic, anhedonic, and melancholic. Anhedonic and melancholic depression subtypes were suggested to be risk factors for increased pain and disability in individuals who developed and experienced symptomatic KOA [34]. Our results suggest that depression scores in working-age women were significantly correlated with preoperative pain and function, and this association was not reported in working-age men.…”

Duloxetine plus exercise for knee osteoarthritis and depression: A feasibility study

“…Another pervasive issue impeding access to treatment among interested patients were depressive symptoms not meeting screening scores for self-reported symptomology (9-Item Patient Health Questionnaire score ≥10) and/or depression not satisfying interviewer-assessed diagnostic criteria for case-level mood disorder [ 8 ]. “Melancholic” depressive symptoms are consistent with the DSM-V definition for major depressive disorder and the most severe among the subgroups of the “depression” knee OA clinical phenotype [ 8 , 14 ]. Symptomology that comports with diagnostic criteria for case-level mood disorder is the least common among knee OA patients, and there are other clinically relevant depression subgroups that have milder and/or different constellations of depressive symptoms [ 14 ].…”

“…“Melancholic” depressive symptoms are consistent with the DSM-V definition for major depressive disorder and the most severe among the subgroups of the “depression” knee OA clinical phenotype [ 8 , 14 ]. Symptomology that comports with diagnostic criteria for case-level mood disorder is the least common among knee OA patients, and there are other clinically relevant depression subgroups that have milder and/or different constellations of depressive symptoms [ 14 ]. There is a paucity of clinical research that has developed and tested prevention strategies for affective disorders in this population, and knee OA patients with depressive symptoms who are at-risk for major depression may benefit from preventive intervention.…”

Prognostic Factors and Changes in Pain, Physical Functioning, and Participation in Patients With Hip and/or Knee Osteoarthritis: A Systematic Review

“…A total of 27 studies employed a prognostic cohort design, 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 whereas the remaining used a retrospective cohort design. 51 , 52 , 53 , 54 A total of 24 studies included patients diagnosed with knee OA, 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 38 , 39 , 40 , 41 , 42 , 47 , 48 , 49 ,…”

“… 51 , 52 , 53 , 54 A total of 24 studies included patients diagnosed with knee OA, 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 38 , 39 , 40 , 41 , 42 , 47 , 48 , 49 , 51 , 52 , 53 , 54 four studies included patients diagnosed with knee and hip OA and analyzed these patient groups separately, 36 , 37 , 45 , 46 three studies included patients with knee and/or hip OA, 43 , 46 , 50 and one study included patients with generalized OA. 44 In 20 studies, the included participants suffered from radiographic OA 24 , 26 , 27 , 28 , 29 , 32 , 33 , 34 , 35 , 38 , 39 , 40 , 41 , 42 , …”