New insights into the prevalence of depressive symptoms and depression in rheumatoid arthritis – Implications from the prospective multicenter VADERA II study

Abstract

Objectives To investigate the prevalence of depressive symptoms in rheumatoid arthritis (RA) patients using two previously validated questionnaires in a large patient sample, and to evaluate depressive symptoms in the context of clinical characteristics (e.g. remission of disease) and patient-reported impact of disease. Methods In this cross-sectional study, the previously validated Patient Health Questionnaire (PHQ-9) and Beck-Depression Inventory II (BDI-II) were used to assess the extent of depressive symptoms in RA patients. Demographic background, RA disease activity score (DAS28), RA impact of disease (RAID) score, comorbidities, anti-rheumatic therapy and antidepressive treatment, were recorded. Cut-off values for depressive symptomatology were PHQ-9 ≥5 or BDI-II ≥14 for mild depressive symptoms or worse and PHQ-9 ≥ 10 or BDI-II ≥ 20 for moderate depressive symptoms or worse. Prevalence of depressive symptomatology was derived by frequency analysis while factors independently associated with depressive symptomatology were investigated by using multiple logistic regression analyses. Ethics committee approval was obtained, and all patients provided written informed consent before participation. Results In 1004 RA-patients (75.1% female, mean±SD age: 61.0±12.9 years, mean disease duration: 12.2±9.9 years, DAS28 (ESR): 2.5±1.2), the prevalence of depressive symptoms was 55.4% (mild or worse) and 22.8% (moderate or worse). Characteristics independently associated with depressive symptomatology were: age <60 years (OR = 1.78), RAID score >2 (OR = 10.54) and presence of chronic pain (OR = 3.25). Of patients classified as having depressive symptoms, only 11.7% were receiving anti-depressive therapy. Conclusions Mild and moderate depressive symptoms were common in RA patients according to validated tools. In routine clinical practice, screening for depression with corresponding follow-up procedures is as relevant as incorporating these results with patient-reported outcomes (e.g. symptom state), because the mere assessment of clinical disease activity does not sufficiently reflect the prevalence of depressive symptoms. Clinical trial registration number This study is registered in the Deutsches Register Klinischer Studien ( DRKS00003231 ) and ClinicalTrials.gov ( NCT02485483 ).

Depression: a common comorbidity in women with rheumatoid arthritis—results from an Austrian cross-sectional study

“…It bears comparison with a recently published German study, which our findings are in line with. In this VADERA II study including both male and female patients with RA and using the BDI II, a predecessor of the BDI-FS, the prevalence of mild and moderate depressive symptoms was also common: 55.4% (mild or worse) and 22.8% (moderate or worse) 37…”

Rheumatoid Arthritis: The Impact of Mental Health on Disease: A Narrative Review

“…The Beck Depression Inventory Scale II (BDI-II) with high sensitivity and specificity (72.7% & 78.4% respectively) was used in a cross-sectional study to measure the severity of depression in RA patients, and it was found that the cut-off point on the BDI-II scale for depression should be higher in patients with chronic pain [38,39]. Another cross-sectional study, the VADERA II study, showed at least mild depression on the BDI-II scale in 27.7% (95% CI 24.91-30.63) of RA patients [40]. The severity of depression was measured by the Hamilton Depression Rating Scale (HAM-D) in a retrospective study [41].…”

Different aspects of opioid use in rheumatoid arthritis patients

“…A high proportion of patients who take antidepressants and opioids concurrently corresponds to the data indicating that depression occurs in 22.5% of patients with chronic pain 30 , while in RA patients depressive symptoms were observed in 12-55% of respondents, depending on the kind of questionnaire used and its level of detail 31 . Moreover, it was determined that in the group of patients with mainly moderate or high RA activity measured with DAS23, a depressive episode in the course of recurrent depression is an important factor in the persistence of pain, and tailored antidepressant treatment leads to a lasting reduction in pain intensity 32 .…”

“…Moreover, it was determined that in the group of patients with mainly moderate or high RA activity measured with DAS23, a depressive episode in the course of recurrent depression is an important factor in the persistence of pain, and tailored antidepressant treatment leads to a lasting reduction in pain intensity 32 . On the other hand, chronic pain and inflammation increase the risk of depressive symptoms, but it is unclear whether chronic pain is a depressive factor in RA or whether the relationship is bi-directional 31 . Apart from depression, a very common phenomenon in people with chronic pain is anxiety, which, similarly to depressive symptoms, influences the perception of pain and often leads to extreme focus on the symptoms of the disease 33 .…”