Prevalence of depressive symptoms in patients with rheumatoid arthritis at a regional hospital in KwaZulu-Natal, South Africa

Abstract

Background: Depression affects 14.8% – 38.8% of patients with rheumatoid arthritis (RA) in developed countries. The prevalence and risk factors for depression in patients with RA in sub-Saharan Africa is not well established.Aim: To determine the prevalence of depressive symptoms in patients with RA.Setting: Public sector regional hospital in South Africa.Methods: A cross-sectional descriptive study was undertaken with 110 adult RA patients. A structured socio-demographic and clinical questionnaire, the modified health assessment questionnaire (mHAQ), the simplified disease activity index (SDAI) for RA, the patient health questionnaire (PHQ-9), and the Household Food Insecurity Access scale (HFIAS) for nutritional status, were used. Correlates of depressive symptomatology in participants with RA were identified using t-tests and regression analyses.Results: Most of the participants were women (90.9%), 67% had moderate to severe RA disease on the SDAI score, 92.7% reported functional disability (HAQ score of ≥ 1), and 87.2% reported mild to severe depressive symptoms. Unemployment (p 0.01), severe food insecurity (p 0.01) and functional disability (p = 0.02), were significantly associated with the depressive symptoms, but not with disease activity (p = 0.8) or inflammatory markers (p = 0.63). Unemployment (adjusted β = −5.07, p 0.01) and severe food insecurity (adjusted β = −4.47, p 0.01) were significantly associated with depressive symptoms, based on the adjusted regression model.Conclusion: As RA effects functional status, with the impact of the resulting unemployment and food insecurity being associated with depression, affected people should be screened for depression and managed using a multidisciplinary approach, especially considering the role of social determinants in RA patients with depression.

Comorbidities and extra-articular manifestations of Rheumatoid arthritis in sub-Saharian Africa

“…The prevalence of arterial hypertension varied between 11.7 and 70% [1,12,[14][15][16][17][18], that of diabetes between 4.3 and 15.3% [4,6,12,[15][16][17][18] and that of obesity between 40 and 58.8% [1,11,13,17] of subjects. Between 2 and 70.5% had depression [1,11,15], 2% cancer [1,12] and between 23.5 and 74.2% dyslipidemia [1,6,12]. The prevalence of asthma varied between 2.3 and 4.3% [14,18] and gout was reported in 5.8% [17] of subjects.…”

“…The prevalence of asthma varied between 2.3 and 4.3% [14,18] and gout was reported in 5.8% [17] of subjects. HIV infection was present in 2.1 to 9.3% of the subjects surveyed [11][12]15]. (Table II) Nodules were observed in 3 to 41.17% [4,12,[17][18][19][20], pulmonary involvement in 2.7 to 8.9% [4,12,18,[20][21] and cardiac involvement in 4 to 32% of subjects [1,4,12].…”

“…Several situations promote the occurrence or aggravation of these extra-articular manifestations, including the environment, age, male sex, but also certain modifiable factors such as smoking, diet, obesity, dyslipidemia, high blood pressure or diabetes [8,9]. To these, we also (add) cite depression favored by the pain felt by the patient, impaired quality of life, extra-articular manifestations and comorbidities [10,11]. The latter are already present in a third of patients screened for polyarthritis and can reach 80% in the long term in developed countries and a higher prevalence in developing countries [12].…”