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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 43  |  Issue : 1  |  Page : 23-26

Anxiety and depression regression and correlation as to rheumatoid arthritis patients’ clinical and sociodemographic characteristics


1 Asst. Prof. Psychiatry Neuropsychiatry Department, Faculty of Medicine, Helwan University, Cairo, Egypt
2 Lecturer Rheumatology Rheumatology Department, Faculty of Medicine, Helwan University, Cairo, Egypt

Date of Submission27-Jan-2021
Date of Decision05-Feb-2021
Date of Acceptance27-Feb-2021
Date of Web Publication26-Feb-2022

Correspondence Address:
Samah Rabei
Asst. Prof. Psychiatry Helwan University, Cairo, 11727
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejpsy.ejpsy_10_21

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  Abstract 


Background Studying anxiety and depression correlates to rheumatoid arthritis (RA) patients’ clinical and sociodemographic characteristics is rare in Egypt, so it is necessary to conduct this study.
Results In total, 40 patients in rheumatology clinics of the Faculty of Medicine, Helwan University, assessed by International Classification of Diseases Version 10 symptom checklist and disease activity score 28, rendered a positive correlation between BMI and depression; regression of anxiety over the level of education; also regression of depression over the presence of comorbidity.
Conclusion BMI, the presence of comorbidities, and level of education with RA relate to the presence of anxiety and depression in patients with RA.

Keywords: anxiety, depression, rheumatoid arthritis


How to cite this article:
Rabei S, el Sonbaty H. Anxiety and depression regression and correlation as to rheumatoid arthritis patients’ clinical and sociodemographic characteristics. Egypt J Psychiatr 2022;43:23-6

How to cite this URL:
Rabei S, el Sonbaty H. Anxiety and depression regression and correlation as to rheumatoid arthritis patients’ clinical and sociodemographic characteristics. Egypt J Psychiatr [serial online] 2022 [cited 2022 Jul 7];43:23-6. Available from: http://new.ejpsy.eg.net/text.asp?2022/43/1/23/338553




  Background Top


Prevalence of anxiety and depression in patients with rheumatoid arthritis (RA) varies in studies in different countries and different decades. Matcham et al. (2013), in a meta-analysis of 72 studies that included 13 189 patients with RA, found a pooled prevalence of major depression of 17% (range: 3–75%) (Matcham et al., 2013). Katchamart et al. (2020) in a multicenter prospective cross-sectional study, including 464 patients, found that 12.5 and 14.5% of patients with RA had depression and anxiety, respectively (Katchamart et al., 2020). Jamshidi et al. (2016) found an 84% prevalence of anxiety among Iranian patients with RA (Jamshidi et al., 2016).

Mental and physical health states have mutual influence over each other. Machin et al. (2020), in a systematic review and meta-analysis, including 20 studies involving 7452 people with RA, found that anxiety was associated with increased RA activity (Machin et al., 2020). Rathbun et al. (2013), in a systematic review, found a bidirectional relationship between depression and RA activity (Rathbun et al., 2013). Matcham et al. (2018), in an analysis of the British Society for Rheumatology Biologics Register, found that depressive symptoms in patients with RA were linked to a reduced improvement in disease activity score 28 (DAS28) over time, compared with patients without depression (Matcham et al., 2018). Patients with RA having anxiety, depression, or both improve when physical and chemical therapies to RA improve their physical state. Jorm et al. (2017), in a review of the evidence from four countries, found that increased provision of treatment reduced the prevalence of common mental disorders (Jorm et al., 2017).

Tucrck et al. (2017), in a study of the proteomic differences in blood plasma associated with antidepressant-treatment response, found that depression influences the disease process itself and not simply the self-rated impact of disease. This is no surprise given the known influences of depression and its treatments upon the immune system (Tucrck et al., 2017). Lu et al. (2016), in a Taiwan nationwide longitudinal study of the bidirectional associations between RA and depression, found that RA activity and depressive symptoms are mutually associated and that systemic inflammation may cause or contribute to depressive symptoms (Lu et al., 2016). Withers et al. (2017) explained that the direct effect of proinflammatory cytokines on the central nervous system, as well as the indirect effects of disease activity, such as pain, disability, loss of social life, and fear of disease progression, contributes to depression (Withers et al., 2017).

Margaretten et al. (2011) reported that sociodemographic and clinical variables have an impact on depression in patients with RA (Margaretten et al., 2011). This study investigates these sociodemographic and clinical variables in an Egyptian sample. It could help in raising the index of clinical suspicion of the rheumatologist for early diagnosis and referral of patients with depression and anxiety among rheumatoid patients for psychiatric services.


  Patients and methods Top


Participants

Sample selection: convenience sample of patients with RA following up in the Rheumatology clinic in Badr Hospital of Helwan University

Sample size: is calculated using Epi-Info program, version 6 (Centers for disease control and prevention in Atlanta, Georgia (US), (1998)) assuming 95% confidence interval, 80% power of test; accordingly, the following equation is used:



n: the sample size, p: the expected prevalence, z: the critical value 1.96, e: the margin of sample error tolerated to 0.05.

The expected prevalence according to Matcham et al. (2013) is 3%. Therefore, the sample size was calculated to be 40 participants.

Tools

Participants were asked to complete the sociodemographic and clinical data sheet − age, sex, education, duration of illness, weight, height, presence of comorbid illnesses, and presence of joint deformities − ensured from clinic records as well.

The participants were interviewed by a psychiatrist and diagnosed according to the International Classification of Diseases Version 10 symptom checklist (Janca and Hiller, 1996).

The participants were examined by a rheumatologist and severity of illness assessed according to the DAS28.

Procedures

Study design survey design. Ethical approval: approval from the ethical committee of the Faculty of Medicine Helwan University was obtained. Written informed consent was given by participants. Data collection: time table: data collection lasted for 3 months beginning from the January 1, 2020 till the sample was completed. Settings: Rheumatology Clinic (Helwan University hospitals).

Statistical analyses

All analyses were performed on the Statistical Package for Social Sciences (SPSS, version 20.0; IBM, Armonk, New York, USA) (Nile et al., 2011). Descriptive statistics (means and SDs or frequency and percentages) were calculated for the collected variables. Linear regression and Pearson’s correlation were used to investigate regression and correlate variables.


  Results Top


Psychosocial and clinical characteristics

Tabulated in [Table 1]. Females are 87.5% of sample. About 47.5% have higher education and 42.5% have school education. Deformity occurs in 32.5% of sample and comorbidity in 40% of sample. Anxiety occurs in 27.5% and depression in 20% of sample. Mean age is 43 years and mean disease duration is 6.73 years. Mean BMI is 30.12 and mean DAS28 is 3.54.
Table 1 Psychosocial and clinical characteristics

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Regression and correlation of anxiety and depression as regards other variables

There is significant regression of anxiety as to educational level, while there is significant regression of depression as to the presence of comorbidity ([Table 2] and [Table 3]).
Table 2 Regression of anxiety as to sociodemographic and clinical variables (multinominal logistic regression)

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Table 3 Regression of depression as to sociodemographic and clinical variables (multinominal logistic regression)

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There is no significant correlation of anxiety as to age, duration of RA, BMI, and DAS28; while there is significant regression of depression as to the duration of RA ([Table 4] and [Table 5]).
Table 4 Correlation of anxiety as to sociodemographic and clinical variables (Pearson correlation)

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Table 5 Correlation of depression as to sociodemographic and clinical variables (Pearson correlation)

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  Discussion Top


In the present study, anxiety occurs in 27.5% and depression in 20% of sample ([Table 1]). This agrees with Matcham et al. (2013), in their meta-analysis of 72 studies that included 13 189 patients with RA, where they found a pooled prevalence of major depression of 17% (Matcham et al., 2013). Butthis study disagrees with Jamshidi et al. (2016) who found an 84% prevalence of anxiety among Iranian patients with RA. The variation in findings between different studies could be explained by technical factors such as sampling methods and sizes, as well as different tools used in assessing rheumatoid severity and mental symptoms. Also, the variation between studies’ findings could be explained to different sociodemographic and clinical services across different parts of the world. Further studies are needed to explore these hypotheses.In this study, females are 87.5% of sample. There is a statistically insignificant regression between sex and depression in this study, yet the P value is 0.084 ([Table 3]). Margaretten et al. (2011) reported that female sex is a risk factor for depression among patients with RA. Had the sample size been larger, a significant relation might have been evident.

In this study, there is significant regression of anxiety as to educational level ([Table 2]). This agrees with Margaretten et al. (2011) who reported that less formal education was also observed to be a risk factor for depression among RA patients. This also agrees with Zhang et al. (2017) who reported that low education levels are significantly associated with anxiety and depression in RA patients in a Chinese sample (Zhang et al., 2017).

In this study, deformity occurs in 32.5% of sample and comorbidity in 40% of sample. There is significant regression of depression as to the duration of RA ([Table 5]). Katchamart et al. (2020) did a multivariate analysis that revealed global health score to be negatively associated with depression. There is significant regression of depression as to the presence of comorbidity in this study as well.

In Katchamart et al. (2020) study also, anxiety, and functional disability were significantly associated with increased anxiety. Abdul Rahim and Cheng (2018) reported that functional status was noted to be an important predictor of depression and anxiety in patients with RA in a Malaysian center.

In this study, there is significant regression of depression as to the duration of RA. In Katchamart et al. (2020) study also, disease duration of 10 years or more and global health score were significantly associated with decreased risk of developing anxiety. The longer the RA duration is, the less prone to anxiety are the patients and the more prone to depression.


  Conclusion Top


BMI, the presence of comorbidities, and level of education with RA relate to the presence of anxiety and depression in patients with RA.

Acknowledgements

Authors’ contributions: Authors including S.R. and H.S. shared together the steps of design, background review, statistical analysis, results’ representation, and discussion. All authors read and approved the paper.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.







[17]

 
  References Top

1.
Abdul Rahim R, Cheng CH (2018). Self-reported symptoms of depression, anxiety and stress among patients with rheumatoid arthritis in a Malaysian rheumatology centre − prevalence and correlates. Med J Malaysia 73:226–232.  Back to cited text no. 1
    
2.
Centers for Disease Control and Prevention, (1998). Epi info program version 6. Georgia (US): Centers for Disease Control and Prevention in Atlanta.  Back to cited text no. 2
    
3.
Jamshidi AR, Banihashemi AT, Paragomi P, Hasanzadeh M, Barghamdi M, Ghoroghi S (2016). Anxiety and depression in rheumatoid arthritis: an epidemiologic survey and investigation of clinical correlates in Iranian population. Rheum Int 36:1119–1125.  Back to cited text no. 3
    
4.
Janca A, Hiller W (1996). International classification of disease symptoms checklist. Division of mental health. Geneva, Switzerland: World Health Organization.  Back to cited text no. 4
    
5.
Jorm AF, Patten SB, Brugha TS, Mojtabai R (2017). Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry 16:90–99.  Back to cited text no. 5
    
6.
Katchamart W, Narongroeknawin P, Chanapai W, Thaweeratthakul P, Srisomnuek A (2020). Prevalence of and factors associated with depression and anxiety in patients with rheumatoid arthritis: a multicenter prospective cross-sectional study. Int J Rheum Dis 23:302–308.  Back to cited text no. 6
    
7.
Lu MC, Guo HR, Lin MC, Liventh H, Lai NS, Tsai TY (2016). Bidirectional associations between rheumatoid arthritis and depression: a nationwide longitudinal study. Sci Rep 6:20647.  Back to cited text no. 7
    
8.
Machin AR, Babatunde O, Haththotuwa R, Scott I, Blagojevic-Bucknall M, Corp N et al. (2020). The association between anxiety and disease activity and quality of life in rheumatoid arthritis: a systematic review and meta-analysis. Clin Rheumatol 39:1471–1482.  Back to cited text no. 8
    
9.
Margaretten M, Barton J, Julian L, Katz P, Trupin L, Tonner C et al. (2011) Socioeconomic determinants of disability and depression in patients with rheumatoid arthritis. Arthritis Care Res (Hoboken) 63:240–246.  Back to cited text no. 9
    
10.
Matcham F, Rayner L, Steer S, Hotopf M (2013). The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology 52:2136–2148.  Back to cited text no. 10
    
11.
Matcham F, Davies R, Hotopf M, Hyrich KL, Norton S, Steer S, Galloway J (2018) The relationship between depression and biologic treatment response in rheumatoid arthritis: an analysis of the British Society for Rheumatology Biologics Register. Rheumatology (Oxford) 57:835–843.  Back to cited text no. 11
    
12.
Nile NH, Bent DH, Hull CH (2011). Statistical package for social sciences (SPSS) version 20.0. Armonk, NY, USA: International Business Machines (IBM.  Back to cited text no. 12
    
13.
Rathbun AM, Reed GW, Harrold LR (2013). The temporal relationship between depression and rheumatoid arthritis disease activity, treatment persistence and response: a systematic review. Rheumatology 52:1785–1794.  Back to cited text no. 13
    
14.
Tucrck CW, Guest PC, Maccarrone G, Ising M, Kloiber S, Lucae S, Holsboer F, de-Souza DM (2017). Proteomic differences in blood plasma associated with antidepressant treatment response. Front Mol Neurosci 10:272.  Back to cited text no. 14
    
15.
Van Riel PLCM (2014). The development of the disease activity score using 28 joint counts. Clin Exp Rheumatol 332 (suppl. 85):S65–S74.  Back to cited text no. 15
    
16.
Withers MH, Gonzalez LT, Karpouzas GA (2017). Identification and treatment optimization of comorbid depression in rheumatoid arthritis. Rheumatol Ther 4:281–291.  Back to cited text no. 16
    
17.
Zhang L, Xia Y, Zhang Q, Fu T, Yin R, Guo G et al. (2017). The correlations of socioeconomic status, disease activity, quality of life and depression/anxiety in Chinese patients with rheumatoid arthritis. Psychology, Health and Medicine 22:28–36.  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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