Abstract
BackgroundDepression 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.AimTo determine the prevalence of depressive symptoms in patients with RA.SettingPublic sector regional hospital in South Africa.MethodsA 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.ResultsMost 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.ConclusionAs 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.
Highlights
Untreated rheumatoid arthritis (RA) is associated with increased morbidity, mortality and poorer quality of life.[1,2] Studies show that more than a third of formerly working persons are no longer able to perform work after 5 years of being diagnosed with RA, with this proportion increasing to more than 50% after 10 years.[3]
The main study findings are that there was a high prevalence of depressive symptoms in patients with RA, and that these were associated with unemployment (p < 0.01), severe food insecurity (p < 0.01), and impaired functional level [health assessment questionnaire (HAQ) score 1 or more] (p < 0.02)
The logistic regression showed that only unemployment and severe food insecurity were associated with depressive symptoms, and that there was no association with any clinical variables of RA, including C-reactive protein (CRP) levels
Summary
Untreated rheumatoid arthritis (RA) is associated with increased morbidity, mortality and poorer quality of life.[1,2] Studies show that more than a third of formerly working persons are no longer able to perform work after 5 years of being diagnosed with RA, with this proportion increasing to more than 50% after 10 years.[3] Affected persons have to find alternative sources of income, if possible, but are often not able to perform their routine daily tasks and activities, which can result in inactivity,[4] dependence on others and depression. 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
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