Objectives: The study goals were to (1) estimate the prevalence of depressive symptoms among a community based panel of persons with rheumatoid arthritis (RA); (2) assess differences in sociodemographic characteristics of individuals with and without depressive symptoms; and (3) assess the association of depressive symptoms with clinical characteristics, function, and health services utilization.
Methods: Depressive symptoms were assessed with the Geriatric Depression Scale. Clinical characteristics examined were number of painful joints, pain rating, and self-reported health status and worsening of RA. Measures of function were the Health Assessment Questionnaire (HAQ), bed days, presence of major physical limitation, and work status. Utilization measures were RA and non-RA related physician visits and hospitalizations. Differences in sociodemographic characteristics were assessed using t tests and chi 2 tests. The association of depression with clinical, function, and utilization variables was assessed using multiple linear and logistic regression. Cross sectional analyses of data from 4 years were performed.
Results: 15-17% of persons reported depressive symptoms each year; 4% in every year. Depression in one year greatly increased the probability of depression in future years. Depressed individuals were less likely to be married, and had RA of longer duration and more comorbidities; there were no significant differences in age, ethnicity, sex, or education between the groups. Depression was associated with significantly poorer clinical characteristics and function on all variables in every year. Differences in utilization were less consistent, but generally the depressed group reported significantly more RA related physician visits and hospitalizations.
Conclusion: Depressive symptoms were consistently associated with negative health and functional outcomes, and, in most cases, with increased health services utilization.