The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis
Faith Matcham, Lauren Rayner, Sophia Steer, Matthew Hotopf, Faith Matcham, Lauren Rayner, Sophia Steer, Matthew Hotopf
Abstract
Objective: There is substantial uncertainty regarding the prevalence of depression in RA. We conducted a systematic review aiming to describe the prevalence of depression in RA.
Methods: Web of Science, PsycINFO, CINAHL, Embase, Medline and PubMed were searched for cross-sectional studies reporting a prevalence estimate for depression in adult RA patients. Studies were reviewed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and a meta-analysis was performed.
Results: A total of 72 studies, including 13,189 patients, were eligible for inclusion in the review. Forty-three methods of defining depression were reported. Meta-analyses revealed the prevalence of major depressive disorder to be 16.8% (95% CI 10%, 24%). According to the PHQ-9, the prevalence of depression was 38.8% (95% CI 34%, 43%), and prevalence levels according to the HADS with thresholds of 8 and 11 were 34.2% (95% CI 25%, 44%) and 14.8% (95% CI 12%, 18%), respectively. The main influence on depression prevalence was the mean age of the sample.
Conclusion: Depression is highly prevalent in RA and associated with poorer RA outcomes. This suggests that optimal care of RA patients may include the detection and management of depression.
Keywords: depression; meta-analysis; prevalence; rheumatoid arthritis; systematic review.
Figures
References
- Waraich P, Goldner EM, Somers JM, et al. Prevalence and incidence studies of mood disorders: a systematic review of the literature. Can J Psychiatry. 2004;49:124–38.
- Atal SA, Ceceli E, Okumu M, et al. The evaluation of pain in patients with rheumatoid arthritis. Pain Pract. 2009;9:31.
- van Hoogmoed D, Fransen J, Bleijenberg G, et al. Physical and psychosocial correlates of severe fatigue in rheumatoid arthritis. Rheumatology. 2010;49:1294–302.
- Mikuls T, Saag K, Criswell L, et al. Health related quality of life in women with elderly onset rheumatoid arthritis. J Rheumatol. 2003;30:952–7.
- El-Miedany YM, El Rasheed AH. Is anxiety a more common disorder than depression in rheumatoid arthritis? Joint Bone Spine. 2002;69:300–6.
- Joyce AT, Smith P, Khandker R, et al. Hidden cost of rheumatoid arthritis (RA): estimating cost of comorbid cardiovascular disease and depression among patients with RA. J Rheumatol. 2009;36:743–52.
- Spicer JG. Health-related quality of life: covariance structural equation modeling in the evaluaton of symptom status and support in persons with rheumatoid arthritis. PhD thesis, University of California, San Francisco 1998:147.
- Katz PP, Yelin EH. Prevalence and correlates of depressive symptoms among persons with rheumatoid arthritis. J Rheumatol. 1993;20:790–6.
- Ang DC, Choi H, Kroenke K, et al. Comorbid depression is an independent risk factor for mortality in patients with rheumatoid arthritis. J Rheumatol. 2005;32:1013–9.
- Lok EYC, Mok CC, Cheng CW, et al. Prevalence and determinants of psychiatric disorders in patients with rheumatoid arthritis. Psychosomatics. 2010;51:338–38.e8.
- Isik A, Koca SS, Ozturk A, et al. Anxiety and depression in patients with rheumatoid arthritis. Clin Rheumatol. 2007;26:872–8.
- Geisser ME, Roth RS, Robinson ME. Assessing depression among persons with chronic pain using the Center for Epidemiological Studies Depression Scale and the Beck Depression Inventory: a comparative analysis. Clin J Pain. 1997;13:163–70.
- Covic T, Pallant JF, Tennant A, et al. Variability in depression prevalence in early rheumatoid arthritis: a comparison of the CES-D and HAD-D Scales. BMC Musculoskelet Disord. 2009;10:18.
- 4th edn (DSM-IV) Washington, DC: American Psychiatric Association; 1994. Diagnostic and statistical manual of mental disorders.
- ICD-10 classification of mental and behavioural disorders. Diagnostic criteria for research. 10th revision (ICD-10). Geneva: World Health Organisation, 1993.
- Hotopf M, Chidgey J, Addington-Hall J, et al. Depression in advanced disease: a systematic review. Part 1. Prevalence and case finding. Palliat Med. 2002;16:81–97.
- Spitzer R, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA. 1999;282:1737–44.
- Knudsen AK, Hotopf M, Skogen JC, et al. The health status of nonparticipants in a population-based health study. Am J Epidemiol. 2010;172:1306–14.
- Barlow JH, Cullen LA, Rowe IF. Comparison of knowledge and psychological well-being between patients with a short disease duration (<=1 year) and patients with more established rheumatoid arthritis (>=10 years duration) Patient Educ Couns. 1999;38:195–203.
- Hider SL, Tanveer W, Brownfield A, et al. Depression in RA patients treated with anti-TNF is common and under-recognized in the rheumatology clinic. Rheumatology. 2009;48:1152–4.
- Dickens C, McGowan L, Clark-Carter D, et al. Depression in rheumatoid arthritis: a systematic review of the literature with meta-analysis. Psychosom Med. 2002;64:52–60.
- Moher D, Liberati A, Tetzlaff J, et al. The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;62:1006–12.
- Higgins JPT, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.
- Barnard KD, Skinner TC, Peveler R. The prevalence of co-morbid depression in adults with Type 1 diabetes: systematic literature review. Diabet Med. 2006;23:445–8.
- Reijnder JSAM, Ehrt U, Weber WEJ, et al. A systematic review of prevalence studies of depression in Parkinson's disease. Mov Dis. 2008;23:183–9.
- Mitchell AJ, Chan M, Bhatti H, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011;12:160–74.
- Gabriel SE. The epidemiology of rheumatoid arthritis. Rheum Dis Clin North Am. 2001;27:269–81.
- Piccinelli M, Wilkinson G. Gender differences in depression. Br J Psychiatry. 2000;177:486–92.
- Blazer D, Burchett B, Service C, et al. The association of age and depression among the elderly: an epidemiologic exploration. J Gerontol. 1991;46:M210–5.
- Wasteson E, Brenne E, Higginson IJ, et al. Depression assessment and classification in palliative care patients: a systematic literature review. Palliat Med. 2009;23:739–53.
- Moran PJ, Mohr DC. The validity of the Beck Depression Inventory and Hamilton Rating Scale for Depression items in the assessment of depression among patients with multiple sclerosis. J Behav Med. 2005;28:35–41.
- Martens MP, Parker JC, Smarr KL, et al. Assessment of depression in rheumatoid arthritis: a modified version of the Center for Epidemiological Studies Depression Scale. Arthritis Rheum. 2003;49:549–55.
- Goodenow C, Reisine ST, Grady KE. Quality of social support and associated social and psychological functioning in women with rheumatoid arthritis. Health Psychol. 1990;9:266–84.
- Wilkins KE. A psychosocial model for the impact of rheumatoid arthritis on well-being. Diss Abstr Int. 2000;61:384.
- Farmer DF, Jackson SA, Camacho F, et al. Attitudes of African American and low socioeconomic status white women toward medical research. J Health Care Poor Underserved. 2007;18:85–99.
- Miech RA, Caspi A, Moffitt TE, et al. Low socioeconomic status and mental disorders: a longitudinal study of selection and causation during young adulthood. Am J Sociol. 1999;104:1096–131.
- Bengtsson C, Nordmark B, Klareskog L, et al. Socioeconomic status and the risk of developing rheumatoid arthritis: results from the Swedish EIRA study. Ann Rheum Dis. 2005;64:1588–94.
- Katon WJ, von Korff M, Lin EB, et al. The pathways study: a randomized trial of collaborative care in patients with diabetes and depression. Arch Gen Psychiatry. 2004;61:1042–9.
Source: PubMed