Rheumatoid arthritis patients should be asked about depression

Last Updated: 2008-02-21 12:01:59 -0400 (Reuters Health)

NEW YORK (Reuters Health) – While patients with rheumatoid arthritis (RA), especially those whose activities are more restricted due to their RA, may have depressive symptoms, few depressed patients discuss their condition with their rheumatologists, according to a report in the February issue of Arthritis & Rheumatism.

"Depression is common among patients with RA, with a prevalence of 15-20%," note Dr. Betsy Sleath of the University of North Carolina Sheps Center for Health Services Research, Chapel Hill, and a multicenter team, "and patients with RA are twice as likely as members of the general population to experience depression."

For their current study, the researchers recruited 200 RA patients from four rheumatology clinics, and eight rheumatologists. Medical visits were audiotaped, and the patients were interviewed after their visits. Depressive symptoms were measured with the 9-item validated Patient Health Questionnaire (PHQ), and physicians recorded patients’ American College of Rheumatology (ACR) functional status immediately after the audiotaped visit.

Overall, 25% of patients were rated by their rheumatologists as ACR functional class I, 44.5% were rated as class II, and 16% were rated as class III or IV. Twenty-one patients (10.5%) had moderate to severe symptoms of depression. Results of multivariate logistic regression showed that patients rated as having worse ACR functional status were more than twice as likely to have moderate to severe depressive symptoms compared to those with better functional status.

Of the 21 patients with moderate to severe symptoms of depression, only four (19%) discussed depression during their medical visits. The patients initiated the discussion every time.

"These findings indicate that communication about depression needs to be improved between RA patients and their doctors," Dr. Sleath said in an interview with Reuters Health. "Rheumatologists could ask RA patients if they are experiencing depressive symptoms during visits or their office staff could conduct a brief screening for depression using an instrument like the Patient Health Questionnaire before the patient’s visit and the rheumatologist could discuss the results with patients if needed."

"RA patients need to be encouraged to let their doctors know if they feel depressed," Dr. Sleath said. "There is often a stigma attached to depression which prevents individuals from discussing how they feel with family, friends, or physicians," she pointed out. "But if individuals do not talk about it, it prevents them from getting treatment that may help them."

Arthritis Rheum 2008;59:186-191.