Download The longitudinal impact of persistent depression on physical health outcomes... Rheumatoid Arthritis THU0591-HPR Faith Matcham

The longitudinal impact of persistent depression on physical health outcomes in
Rheumatoid Arthritis
Faith
1
Matcham ,
Sam
2
Norton ,
David L.
3
Scott ,
3
Steer ,
Sophia
Matthew
THU0591-HPR
4
Hotopf
1. Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London, UK.
2. Psychology Department, Institute of Psychiatry , King’s College London, UK.
3. Department of Rheumatology, King’s College Hospital, London, UK.
Background:
Conclusions:
• Approximately 34% of RA patients screen
positive for depression [1].
• Depression in RA associated with
increased mortality, disability and
healthcare costs [2].
• Limited evidence assesses the
longitudinal impact of depression on RA
outcomes, particularly objectivelyreported clinical outcomes.
• Increasing persistence of depression over time is associated
with poor physical health outcomes, with discordance
between subjectively and objectively measured outcomes.
• These findings have significant implications: firstly, that mental health
should be measured and monitored throughout the course of treatment [4];
secondly, the development of mental health interventions may improve
physical health in Rheumatoid Arthritis; thirdly, that DAS-28 scores may be
inflated in depressed patients, which needs to be considered when making
treatment decisions.
Objective: To assess the impact
of persistent depression on
physical health outcomes over a
2-year follow-up period.
References:
1. Matcham F et al. The prevalence of depression in Rheumatoid Arthritis: A systematic review and meta-analysis.
Rheumatology 2013; 52: 2136-48.
2. Bruce T. Comorbid depression in rheumatoid arthritis: Pathophysiology and clinical implications. Current Psychiatry
Reports 2008; 10: 258-64.
3. Choy EHS et al. Factorial randomised controlled trial of glucocorticoids and combination disease modifying drugs in
early rheumatoid arthritis. Ann Rheum Dis 2008; 67: 656-63.
4. Rayner L et al. Embedding integrated mental health assessment and management in general hospital settings:
feasibility, acceptability and the prevalence of common mental disorder. Gen Hosp Psychiatr (in press), doi:
10.1016/j.genhosppsych.2013.12.004.
Methods:
•
•
•
•
•
Secondary analysis of clinical trail data [3].
Depression and physical health outcomes
measured at baseline and 6-montly intervals
for 2-years.
Depression measured using the EQ-5D, and
patients categorised into 4 groups: 1) never
depressed; 2) depressed at < 50% of timepoints; 3) depressed at > 50% of time-points;
and 4) depressed at every time-point. P
Physical health outcomes were: Larsen score;
assessor global assessment (AGA); HAQ; pain;
and DAS-28.
Multi-level regression models with effect sizes
created for each outcome adjusting for key
demographic and clinical variables.
Results:
Figure 1. Estimated unadjusted mean physical health outcomes over time by persistence of
depression/anxiety symptoms (with standard error bars) for Larsen, HAQ, AGA, Pain and DAS-28 outcomes
Table 1. Post-treatment mean differences (b) and standardised mean differences (d) for physical health outcomes by persistence of depression/anxiety symptoms^
HAQ
AGA
b (SE)
d
b (SE)
d
Larsen Score
b (SE)
d
Pain
DAS-28
Never Depressed/Anxious
-
-
-
-
-
-
-
-
-
-
Depressed/Anxious <50%
0.16 (0.07)*
0.22*
5.65 (2.18)*
0.31*
-0.04 (0.06)
-0.04
4.57 (2.30)*
0.21*
0.40 (0.16)*
0.29*
b (SE)
d
b (SE)
d
Depressed/Anxious >50% 0.37 (0.08)*** 0.52*** 9.63 (2.53)*** 0.52*** -0.10 (0.06) -0.09
9.07 (2.71)**
0.42** 0.79 (0.18)*** 0.56***
• Data available for 379 patients.
• Patients’ mean age was 54.1 (12.3),
and 68.3% of the sample were
Always Depressed/Anxious 0.52 (0.08)*** 0.73*** 15.42 (2.77)*** 0.84*** -0.17 (0.07)* -0.16* 20.07 (3.00)*** 0.93*** 1.25 (0.20)*** 0.89***
female.
SJC Swollen Joint Count; ESR erythrocyte sedimentation rate; AGA assessor global assessment; DAS-28 disease activity schedule with 28 joint; HAQ health assessment questionnaire; TJC tender joint count; PGA patient global
• In total, 25.9% were never depressed, assessment. *significant at p<0.05 level **significant at p<0.01 level *** significant at p<0.001 level. ^Adjusted for age, gender, disease duration, time, baseline physical health status, treatment, RF status, use of previous
36.9% were depressed <50% of the
DMARDS, presence of RA nodules.
time, 27.4% were depressed >50% of
the time, and 15.8% were depressed
at every time-point.