Depressive symptoms in Rheumatoid Arthritis patients in a general hospital setting in Kuching / Joven Mailvaganam
Rheumatoid Arthritis is a common, chronic and debilitating autoimmune illness with long-term physical and psychological implications to sufferers. The comorbid diagnosis of depression is a well-known entity in patients with Rheumatoid Arthritis but remains unrecognized due to the lack of vigilanc...
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| Format: | Thesis |
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2019
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| Online Access: | http://studentsrepo.um.edu.my/11322/ http://studentsrepo.um.edu.my/11322/4/joven.pdf |
| Summary: | Rheumatoid Arthritis is a common, chronic and debilitating autoimmune illness with
long-term physical and psychological implications to sufferers. The comorbid diagnosis
of depression is a well-known entity in patients with Rheumatoid Arthritis but remains
unrecognized due to the lack of vigilance on the part of the clinician.
This study was conducted to establish the prevalence of depression among patients with
Rheumatoid Arthritis. We had also aimed to determine the association between sociodemographic profile and clinical parameters of Rheumatoid Arthritis patients with
symptoms of depression. Next, we intended to understand the link between disease
severity of Rheumatoid Arthritis and symptoms of depression. Finally, we evaluated the
association between functional status in Rheumatoid Arthritis and the presence of
depressive symptoms.
This is a hospital-based cross-sectional study on Rheumatoid Arthritis patients in
Hospital Umum Sarawak. Convenience sampling was used in this study. Ethics
approval was obtained from the Malaysian Ethics and Research Committee (MREC).
Patients who consented to the enrolment into this study were given Hospital Anxiety
and Depression Scale (HADS) Questionnaire and Health Assessment Questionnaire
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(HAQ). Disease Severity of Rheumatoid Arthritis was evaluated and scored with the
Disease Activity Score-28 (DAS-28). Socio-demographic and clinical data were also
obtained. Patients who were diagnosed with depression based on HADS were further
evaluated with MINI International Neuropsychiatric Inventory (MINI) to confirm
diagnosis of Major Depressive Disorder and referred to the psychiatry clinic. The
prevalence of depression and patients who reported depressive symptoms was
determined. Univariate and multivariate analysis were done to determine the association
between depressive symptoms and correlates.
Results : A total of 207 patients were recruited in this study. The prevalence of depression in
Rheumatoid Arthritis was 1.5% (n=3). However, 38.7% (n=80) of patients reported
having at least one symptom of depression. Apart from the status of cardiovascular
disease (One-way ANOVA, p=0.032), other Rheumatoid Arthritis clinical parameters
and medical comorbidities were not associated with depressive symptoms. Finally,
socio-demographic data (such as age, sex, marital status, education level and
employment) were not associated with symptoms of depression. Following multivariate
analysis, functional status (based on HAQ score) in Rheumatoid Arthritis was found to
be significantly associated with symptoms of depression (ANCOVA, p<0.001).
Interestingly, disease severity (based on DAS-28 score) of Rheumatoid Arthritis was no
longer associated with depressive symptoms (ANCOVA, p=0.697).
Conclusion
Although the prevalence of depression was low, more than a third of patients had some
form of symptoms of depression. There was a significant association between functional
status of Rheumatoid Arthritis patients towards symptoms of depression. However,
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there was no association between Rheumatoid Arthritis disease severity and depressive
symptoms. Therefore, the author recommends the routine screening for depression and a
more rigorous approach to the improvement of functional status in Rheumatoid Arthritis
patients to minimize the risk of depression. Finally, a larger population and prospective
longitudinal study is also recommended in future research in the region. |
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