Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the hospital, Anxiety and Depression Scale (HADS)

Covic, Tanya; Cumming, Steven; Pallant, Julie; Manolios, Nicholas; Emery, Paul; Conaghan, Philip G.; Tennant, Alan

doi:10.1186/1471-244x-12-6

Cited by 236 publications

(192 citation statements)

References 48 publications

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“…Some additional confounding factors were not possible to control for, as they were not a part of the original program in the early arthritis followup. For example, depression is common in RA 35, and there is a confirmed strong association between pain and depressive symptoms 36. Moreover, several studies have shown that depression and anxiety may impact clinical response to antirheumatic treatment 37.…”

Section: Discussionmentioning

confidence: 99%

Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate

Altawil

Saevarsdóttir

Wedrén

et al. 2016

Arthritis Care & Research

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ObjectiveTo investigate the frequency of remaining pain in early rheumatoid arthritis (RA) after 3 months of treatment with methotrexate as the only disease modifying antirheumatic drug, with a special focus on patients with a good clinical response.MethodsThe study base was cases reported to a population‐based early RA cohort who had followup data from the Swedish Rheumatology Quality Register (n = 1,241). The Disease Activity Score in 28 joints European League Against Rheumatism (EULAR) response criteria were used to evaluate clinical response to treatment as good, moderate, and no response. The primary end point was remaining pain at the 3‐months followup visit, defined as pain >20 mm on a 100‐mm visual analog scale (VAS).ResultsRemaining pain in spite of a EULAR good response at followup was associated with higher baseline disability, using the Health Assessment Questionnaire (adjusted odds ratio [OR] 2.2 [95% confidence interval (95% CI) 1.4–3.4] per unit increase), and less baseline inflammation, using the erythrocyte sedimentation rate (adjusted OR 0.81 [95% CI 0.70–0.93] per 10‐mm increase). Similar associations were detected for remaining pain at followup in spite of low inflammatory activity, defined as a C‐reactive protein level <10. Increase in VAS pain during the treatment period was observed in 19% of the whole cohort, with frequencies in the EULAR response groups of 9% (good response), 15% (moderate response), and 45% (no response).ConclusionThese results are in line with the hypothesis that a subgroup of early RA patients exhibits pain that is not inflammatory mediated, where alternative treatment strategies to traditional antiinflammatory medications need to be considered.

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Section: Discussionmentioning

confidence: 99%

Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate

Altawil

Saevarsdóttir

Wedrén

et al. 2016

Arthritis Care & Research

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“…Individuals with inflammatory diseases are three to four times more likely to experience depression (Covic et al, 2012;Duivis et al, 2011;Margaretten et al, 2011), patients with major depression have been found to have increased proinflammatory markers (Howren et al, 2009), and an experimental inflammatory challenge (ie, endotoxin-induced inflammation) in an otherwise healthy population can increase depressed mood (Reichenberg et al, 2001). Moreover, recent research suggests that inflammation may contribute to depression, in part, by altering social experience.…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in Depressive and Socioemotional Responses to an Inflammatory Challenge: Implications for Sex Differences in Depression

Moieni

Irwin

Jevtić

et al. 2015

Neuropsychopharmacol

236

238

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Substantial evidence demonstrates that inflammatory processes may underlie depression for a subset of patients, including work showing that healthy subjects exposed to an inflammatory challenge show increases in depressed mood and feelings of social disconnection. However, despite the fact that depression is two times as likely to occur in females than males, the vast majority of this work has been carried out in males. Thus, the objective of this study was to determine whether females (vs males) would show greater increases in proinflammatory cytokines, depressed mood, and social disconnection in response to an inflammatory challenge. One hundred and fifteen healthy participants (69 female) completed this double-blind, placebo-controlled, randomized clinical trial in which participants were randomly assigned to receive either a single infusion of low-dose endotoxin (derived from Escherichia coli; 0.8 ng/kg of body weight) or placebo (same volume of 0.9% saline). Interleukin-6 (IL-6), tumor necrosis factor-a (TNF-a), depressed mood, and feelings of social disconnection were assessed hourly. Results showed that endotoxin (vs placebo) led to increases in proinflammatory cytokines (TNF-a, IL-6), depressed mood, and feelings of social disconnection. Females exposed to endotoxin showed greater increases in depressed mood and feelings of social disconnection. Furthermore, increases in TNF-a and IL-6 were correlated with increases in social disconnection for females but not for males. These sex differences in the relationships between inflammatory and socioemotional responses to an inflammatory challenge may be particularly important for understanding why females are two times as likely as males to develop depressive disorders.

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“…A nursing clinic, specialized in newly diagnosed RA patients, underlined the importance of patients receiving support for their feelings, such as frustration and fear of the future [32]. Investigating psychological well-being [10][11] and emotions [33] in relation to RA is necessary to begin to understand what type of interventions patients can benefit from, and to develop interventions based on patients' experiences of everyday life situations.…”

Section: Discussionmentioning

confidence: 99%

“…In spite of significant advances in drug therapy, RA patients still report pain [9], and at least half of all RA patients experience psychological distress such as anxiety and depression [10][11][12]. Studies have shown that psychological distress is a recurrent problem for RA patients and that, unlike disease activity, symptoms of pain, stiffness and functional impairment are significantly associated with levels of psychological distress [12].…”

Section: Introductionmentioning

confidence: 99%