The Relationship Between Depression and Arthritis

Posted on August 19, 2014

Photo: flickr

Both arthritis and depression are common in the United States, with age and obesity trends likely to increase the number of people who suffer from both conditions simultaneously.

Studies have repeatedly demonstrated an association between arthritis symptoms and major depression. Of concern, research has shown that among patients with both conditions, the result is not merely the sum of the suffering and disability associated with each independent illness; when depression coincides with arthritis, studies have found that the conditions are multiplicative rather than additive, amplifying each other.

Arthritis and depression are but one example of the increasingly frequent overlap between medical and behavioral health, and evidence suggests that treating depression reduces arthritis-related healthcare expenditures, increases compliance with arthritis treatment plans, and alleviates physical symptoms.

The Arthritis Problem

According to the CDC's 2013 Morbidity and Mortality Weekly Report, one in five adults in the United States has physician-diagnosed arthritis. For the past 15 years, arthritis has been the most common cause of disability among U.S. adults. Ten years ago, just under 10 percent of U.S. adults, approximately 19 million people, said their activities of daily living were limited by this chronic condition. The number is projected to reach 25 million by 2030.

In older populations, arthritis is widespread: by age 65, at least a third of people in the U.S. have osteoarthritis, and the majority, approximately 80 percent, experience degenerative changes or joint disease. The costs associated with this are enormous: The American Academy of Orthopedic Surgeons (AAOS) reported an estimated annual cost for medical care to treat arthritis and joint pain of $281.5 billion in 2004. Prescription drugs accounted for 23 percent of the expenditures.

The Depression Problem

The Morbidity and Mortality Weekly Report also notes that depression is more common among people with chronic diseases such as diabetes, asthma, cancer, and arthritis. Citing the Behavioral Risk Factor Surveillance System (BRFSS) survey conducted from 2006 to 2008, 9 percent of U.S. adults, of any health status, met the criteria for depression.

Depressive symptoms have been identified as an independent risk factor for all-cause mortality. A study by Wells et al. found an association between depression and disability where the effects of depression were comparable to several major medical conditions.

When Arthritis and Depression Overlap
When arthritis and depression overlap, studies have shown a synergism resulting in worse suffering and disability than that which would be associated with each condition independently. A 1998 study found that osteoarthritis-related knee pain was associated with depression. Other studies demonstrate worse outcomes, lack of adherence to treatment plans, and increased cost of care in patients suffering from both illnesses.

In addition to increased use of pain medication, a bidirectional relationship exists between the two conditions: Yohannes and Canton describe how the fatigue that accompanies depression results in activity avoidance, which decreases muscle conditioning, resulting in increasing arthritis pain while also leading to social isolation, thereby perpetuating depression. They also note that "a previous history of depression is a better predictor of utilizing healthcare than the severity of osteoarthritis symptoms," which implies that the financial burdens of arthritis could be mitigated to some extent by addressing coinciding depression.

While osteoarthritis is the most common form of arthritis, another form, rheumatoid arthritis, shows an even more significant link with depression. The National Institute of Mental Health (NIMH) Catchment Area program reports that the lifetime prevalence of psychiatric disorders among patients with rheumatoid arthritis is 63 percent. "Indeed," state the researchers, "approximately 20 percent of patients with RA are found to have current major depression with potential impact on RA symptoms."

Devellis and Devellis summarize the implications of these studies, stating that "helping arthritis patients obtain relief from their depression promises both to mitigate the added risk associated with depression and to enable the patient and physician to manage the arthritis itself more effectively. A first step to optimal treatment may simply be an awareness of the role that depression can play in the course of arthritis and its treatment." Primary care physicians could screen arthritis patients for depression and refer them for treatment.

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Category(s):Depression

Source material from Brain Blogger


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