Depressive symptoms in South African black patients with Rheumatoid Arthritis
Date
2012-08
Authors
Pillay, Anersha
Journal Title
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Abstract
Background:
Rheumatoid Arthritis (RA) is a chronic auto-immune musculoskeletal disorder of unknown
aetiology that can result in physical disability, chronic pain and impaired quality of life. RA is
associated with an increased prevalence of depression. The presence of depression in RA is
reported to be associated with pain, functional disability, high disease activity and mortality.
This study aims to determine the prevalence of depressive symptoms in a cohort of Black
South African patients attending a Rheumatology outpatient clinic at a public health center. It
also aims to determine the association and correlation between the presence of depressive
symptoms and the sociodemographic profile and RA clinical characteristics of the study
population.
Methodology:
The study was conducted in a Rheumatology out patient clinic. The study sample consisted of
100 systematically selected participants of Black race. The participants completed the
disability questionnaire (HAQ-DI), Visual Analogue Scales (VAS) for pain, fatigue and
disease activity; and the depression and tension subscales of the Arthritis Impact Measurement
Scale (AIMS). The MADRS was then administered to assess depressive symptoms. Study participants were clinically assessed for disability, joint status and disease activity.
Data was analyzed using the SAS version 9.1 statistical program.
Results:
The majority of the sample was female (85%) and unmarried (66%). The prevalence of
current depression was 13.2%, although a further 22.2% of the sample was already stable on
antidepressant treatment. The mean RA disease duration was 12.5 ± 9.2 years.
No significant associations were found between the presence of depression and the
sociodemographic variables. MADRS scores were significantly associated and correlated with
disability (p = 0.002, r = 0.30); fatigue (p = <0.001, r = 0.43); disease activity (p = 0.001,
r = 0.32); AIMS-D (p < 0.001, r = 0.40) and AIMS-T (p < 0.001, r = 0.35). Upon adjusting for
age and clinical status, significant associations remained with MADRS scores and all five
above-mentioned RA variables although correlations weakened slightly.
Conclusions:
Co morbid depression is prevalent in South African Black patients with RA. In order to
improve clinical outcomes in RA, depression must be actively sought and effectively
managed.
Description
A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, in partial fulfilment of the requirements for the degree
of
Master of Medicine in the branch of Psychiatry
Johannesburg, 2012