High Prevalence of Depressive Symptoms Among Ugandan Patients with Rheumatoid Arthritis

Abstract

Background There is a scarcity of data on the burden of depression among Ugandans with rheumatoid arthritis (RA) patients. We aimed to screen for symptoms of depression, their severity and associated factors among patients with RA in Uganda. Patients and Methods A descriptive, cross-sectional study was conducted between September and December 2020 at Mulago National Referral Hospital (MNRH) and Nsambya Hospital. Patients with RA were enrolled consecutively. Data on demographics, disease course and comorbidities and depression symptomatology were collected through an interviewer administered questionnaire. Symptoms of depression were screened for using the depression/anxiety dimension of the EuroQoL questionnaire. Results Forty-eight patients with a median age of 52 (IQR: 43.5–60.5) years were recruited in the study. The majority of the patients were female (91.7%, n=44). Twenty-nine patients (60.4%) had comorbidities with a median Charlson comorbidity score of 3 (IQR: 2–4). Overall, 70.8% (n=34) had depressive symptoms. Patients attending MNRH were more likely to have depressive symptoms (p=0.025). Significantly, patients with depressive symptoms were younger (p=0.027), had lower health index value (p<0.001), and lower overall self-reported health status (p=0.013). At binary logistic regression, patients at MNRH (crude odds ratio (COR): 4.32, 95% confidence interval (CI): 1.16–16.15, P=0.030), patients aged <52 years (COR: 5.24, 95% CI: 1.23–22.28, P=0.025) and those with mild RA (COR: 5.71, 95% CI: 1.15–28.35, P=0.033) were significantly more likely to have depressive symptoms. Increase in age (COR: 0.94, 95% CI: 0.89–0.99, P=0.025), and high visual analogue score (COR: 0.94, 95% CI: 0.89–0.99, P=0.013) were protective. Conclusion Depressive symptoms were common among RA patients in Uganda. Routine screening, diagnosis and management of depression is recommended among young patients to improve quality of life and patient outcomes.

Prevalence of depression in Uganda: A systematic review and meta-analysis

“…The pooled mean age of the participants was 27.19 years (95% CI: 24.31–30.09 years; I 2 = 85.38, p <0.001). A total of eight studies were conducted during the COVID-19 pandemic [ 6 , 14 , 16 , 33 , 53 , 168 – 171 ].…”

“…The prevalence of depression ranged from 0.4% among outpatients in northern Uganda [ 109 ] and 88% among patients with stomas [ 32 ]. The prevalence among those who (i) were elderly was 18% [ 57 ], (ii) had tuberculosis was 23.7% [ 152 ], (iii) had post-tuberculosis lung diseases was 24% [ 122 ], (iv) had cancer was 26% [ 17 ], (v) with post-stroke was 31.5% [ 131 ], (vi) were physically ill was 33.7% [ 124 ], (vii) had diabetes mellitus was 34.8% [ 115 ], (viii) had sickle cell disease was 68.2% [ 54 ], and (ix) had rheumatoid arthritis was 70.8% [ 33 ]. The pooled prevalence of depression from the 14,405 special patient groups (of whom 855 had depression) in 12 studies was 37.1% (95 CI: 22.3%-52.0%; I 2 = 99.55, p <0.001) ( Fig 8 ).…”

“…These adverse events put many Ugandans at risk of developing depression due to the multiple physical, psychological, emotional, and social difficulties they are associated with. The effects of these difficulties are evidenced by the high levels of depression within various study groups in the country, such as women, children, students, individuals living with HIV, refugees, and members of the general public, with many groups reporting depression prevalence rates of over 70% [14,[31][32][33][34][35][36][37].…”

Comorbidities and extra-articular manifestations of Rheumatoid arthritis in sub-Saharian Africa

“…The prevalence of arterial hypertension varied between 11.7 and 70% [1,12,[14][15][16][17][18], that of diabetes between 4.3 and 15.3% [4,6,12,[15][16][17][18] and that of obesity between 40 and 58.8% [1,11,13,17] of subjects. Between 2 and 70.5% had depression [1,11,15], 2% cancer [1,12] and between 23.5 and 74.2% dyslipidemia [1,6,12]. The prevalence of asthma varied between 2.3 and 4.3% [14,18] and gout was reported in 5.8% [17] of subjects.…”

Improvement in RAID questionnaire results in patients with rheumatoid arthritis treated with advanced therapies

“…These manifestations have a negative impact on several aspects of patients’ quality of life (QoL) since, in a significant percentage of cases, they involve loss of independence and need for assistance to perform daily life activities. Consequently, the mental health of people with RA is often affected and it is common for the disease to be accompanied by other psychiatric and/or psychological disorders such as depression and anxiety 1–3. This can lead to a loss of self-esteem and negatively affect patients’ social and family relationships as well as their working life 4.…”