Significant Depression Symptoms More Frequent Than Clinically Diagnosed Depression in Patients With RA

Significant depression symptoms are more frequent than clinically diagnosed depression in rheumatoid arthritis (RA), suggesting that some patients with depression may go undiagnosed, according to study results presented at American College of Rheumatology (ACR) Convergence 2020, held virtually from November 5 to 9, 2020. Depression symptoms vs a clinical diagnosis of depression also predicted mortality in patients with RA. 

Patients with RA who met the 1987 classification criteria and were recruited from 1996 through 2011 were eligible for the study. In addition to comprehensive clinical and psychosocial evaluations using standardized instruments, depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CESD), adjusted for RA by eliminating items that may overlap with symptoms of RA. Depression was defined as a CESD score of 16 or more. Researchers used the Disease Activity Score 28-joint erythrocyte sedimentation rate (DAS28 ESR) to quantify RA disease activity. They used multivariable logistic regression models to examine the combined influence of independent variables on the outcome.

The final cohort included 1328 patients with RA (74% women). The medical records of 220 patients (17%) revealed a clinical diagnosis of depression, significantly fewer than the 361 patients (27%) with significant depression symptoms on the CESD (P <.0001). During the study period, there were 305 deaths, of which 31 were of the patients who had been diagnosed clinically with depression and 75 of those with significant depression symptoms on the CESD (10% and 26%, respectively).

Compared with patients without depression or depression symptoms, those with depression or significant depression symptoms were younger (mean age, 58 vs 53 years, respectively; P <.0001) and more likely to be women (69% vs 82%, respectively; odds ratio [OR], 1.97 [95% CI 1.48-2.63]; P <.0001). Patients with vs without depression symptoms had greater disease activity (mean DAS28 ESR, 5.1 [95% CI, 5.0-5.3] vs 4.0 [95% CI, 3.9-4.1], respectively; P <.001).

Logistic regression analysis, adjusted for age and sex, revealed that compared with clinically diagnosed depression, significant depression symptoms predicted all-cause mortality (OR 1.77 [95% CI, 1.49-2.12]; P <.001).

Researchers concluded, “Significant depression symptoms in RA are more frequent than depression diagnosed clinically, suggesting that some patients with depression may go undiagnosed.” They added, “Our findings suggest that strategies to improve the recognition of depression in RA should be studied further.”

Reference

Restrepo JF, Del Rincon I, Escalante A. Depression symptoms but not clinically diagnosed depression predict mortality in rheumatoid arthritis. Presented at: ACR Convergence 2020; November 5-9, 2020. Abstract 0194.