Socioeconomic determinants of disability and depression in patients with rheumatoid arthritis

Abstract

Objective To examine the relationship between functional limitation, socioeconomic inequality, and depression in a diverse cohort of patients with rheumatoid arthritis (RA). Methods The study design was cross-sectional and subjects were from the University of California, San Francisco RA Cohort. Patients were enrolled from 2 rheumatology clinics, an urban county public hospital and a university tertiary care medical center. Age, sex, race/ethnicity, disease activity, functional limitation, and medications were variables collected at clinical visits. The patient’s clinic site was used as a proxy for his or her socioeconomic status. The outcome variable was depressive symptom severity measured by the Patient Health Questionnaire 9. Differences in characteristics between depressed and nondepressed patients were calculated using 2-sided t-tests or the Pearson’s chi-square test. For the multivariate analysis, repeated measures with generalized estimating equations were used. Results There were statistically significant differences between depressed and nondepressed patients related to race/ethnicity, public versus tertiary care hospital rheumatology clinic, disability, and medications. In the multivariate analysis, increased functional limitation and public clinic site remained significantly associated with increased depression scores. A significant interaction existed between clinic site and disability. Mean depression scores rose more precipitously as functional limitation increased at the public hospital rheumatology clinic. Conclusion There are disparities in both physical and mental health among individuals with low socioeconomic status. The psychological effects of disability vary in patients with RA such that a vulnerable population with functional limitations is at higher risk of developing depressive symptoms.

Functional disability and health-related quality of life in South Africans with early rheumatoid arthritis

“…The QUEST-RA studies in 25 countries showed an association between gross domestic product and disease status, including physical disability and psychological health (39). Margaretten et al refer to a "vulnerable population" of RA patients where background poverty and high functional disability give rise to a high risk for mental illhealth (40).…”

Assessment of sleep health in patients with rheumatic disease

“…With notable exceptions [32,40–43], few studies of SES and depression in patients with RA have measured multiple indicators of SES. Future studies need more complete and better markers of SES.…”

Psychological Factors Associated with Response to Treatment in Rheumatoid Arthritis

“…Depression has been consistently associated with worse disease outcomes in patients with RA, including pain, tender joints, poor adherence to medication, increased healthcare service utilization, disability, and higher rates of early retirement [2,5,[39][40][41][42]. Conversely, several studies have demonstrated that functional disability and loss of valued activities, such as employment, are associated with an increased risk of depression [39,42,43]. In addition, depression has been identified as an independent risk factor for cardiovascular disease, myocardial infarction, suicide, and all-cause mortality in patients with RA [44,45].…”