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Arthritis tied to depression, anxiety in low-, middle-income countries

Tristan Manalac
15 Aug 2017

In low- and middle-income countries (LMICs), lifetime self-reported arthritis is significantly associated with mental health comorbidities like depression subtypes and anxiety, a recent study has shown.

“In LMICs collectively, we observed that people with arthritis were consistently more likely to have depression (all subtypes), subclinical psychosis, established psychotic disorder, sleep problems, anxiety, and higher levels of perceived stress,” said researchers.

“The increased mental health comorbidity among those with arthritis was consistently raised in those in both low-income and middle-income countries,” they added.

The study included 245,706 individuals (mean age 38.4±16.0 years; 50.7 percent female), of whom 102,111 were from low-income countries (LIC), while 143,493 were from middle-income countries (MIC). The age- and sex-adjusted prevalence of arthritis in the overall sample, in LICs and in MICs were 22.4, 23.4 and 20.9 percent, respectively. [Sci Rep 2017;7:7138]

Multinomial and logistic regression showed that the presence of arthritis significantly increased the risk of subclinical psychosis (odds ratio [OR], 1.85; 95 percent CI, 1.72 to 1.99; p<0.0001) and psychosis diagnosis (OR, 2.48; 2.05 to 3.01; p<0.001) after adjusting for confounders.

Arthritis was also significantly correlated with higher odds of depression, particularly subsyndromal depression (OR, 1.92; 1.64 to 2.26; p<0.001), brief depressive episodes (OR, 2.14; 1.88 to 2.43; p<0.001) and depressive episodes (OR, 2.43; 2.21 to 2.67; p<0.001) compared to no depression.

On the other hand, binary logistic regression showed that self-reported arthritis was also significantly tied to higher risks of perceived stress (OR, 1.43; 1.33 to 1.53; p<0.001), sleep problems (OR, 2.23; 2.05 to 2.43; p<0.001) and anxiety (OR, 1.75; 1.63 to 1.88; p<0.001).

“This is a good study which studied mental health burden of 46 low- and middle-income countries. In my own research, I found that serum levels of proinflammatory cytokines including TNF-α, IL-6 and IL-17 levels were significantly higher in patients suffering from arthritis than those of healthy subjects,” according to Dr Roger Ho Chun Man, associate professor and consultant psychiatrist in the Department of Psychological Medicine at the Yong Loo Lin School of Medicine, National University Singapore.

“These proinflammatory cytokines were found to be increased in patients suffering from depression. Besides the psychological impact of pain associated with arthritis, depression and arthritis share common biological link,” he added.

The data used for the study were obtained from the World Health Survey, which targeted individuals ≥18 years of age across 70 countries. After excluding data from high-income countries and those with insufficient sampling information, data from 46 countries (LIC: n=20; MIC: n=26) were included in the final analysis.

Using lifetime self-reported arthritis as the exposure variable, multinomial logistic regression was used to determine correlation with psychosis and depression, while binary logistic regression was conducted for the anxiety, sleep problems and perceived stress outcome variables.

“We suggest that people with arthritis are assessed for the mental health conditions assessed in our study (ie, depression, anxiety, sleep disturbance, stress and psychosis) so that appropriate interventions can be provided,” researchers recommended.

“More research is required to understand the mental health burden of arthritis in LMICs and context-specific trials and evaluations in LMICs therefore are urgently needed,” they added.

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