NEW YORK (Reuters Health)—Depressed individuals over age 50 should be screened for arthritis pain because the two conditions often occur together, worsening mental and physical health outcomes, researchers say.
“Our findings shed light on the high rates of self-reported, doctor-diagnosed arthritis in U.S. older adults with varying degrees of depression,” Dr. Jessica Brooks of the University of North Texas in Denton, told Reuters Health by email.
“Given the intersecting physical and psychosocial aspects of these two conditions, it is important to screen for, diagnose, and treat these common conditions in both medical and mental health clinics,” said Dr. Brooks, who was a postdoctoral fellow at Dartmouth College in Hanover, New Hampshire during the study.
“Primary care providers and rheumatologists need to increase emphasis on depression screening and routinely refer arthritis patients for appropriate mental health care,” she noted. “Additionally, mental health and behavioral health providers should also be aware of the high likelihood of arthritis co-occurring in older adults with or at risk for depression.”
“This means that they, too, should provide regular arthritis-related pain assessments and evidence-based treatments such as cognitive-behavioral therapy for both pain and depression management,” she said.
Dr. Brooks and colleagues studied 4,792 individuals with depression and self-reported doctor-diagnosed arthritis. Participants’ mean age was 64.5; 43.7% were white, 56.7% were hypertensive, 39.3% were obese, 22.5% had type 2 diabetes; and 7.1% had heart disease.
As reported online September 19 in the International Journal of Geriatric Psychiatry, arthritis prevalence rates were higher in those with minor (55%), moderate (62.9%) and severe (67.8%) depression. Rates increased with age, with the highest rates among those between 70 to 79 (55%) and 80+ (57.1%).
Among participants with varying degrees of depression severity, arthritis rates ranged from 53.1% to 73.7%, with the largest increase in prevalence in participants ages 50 to 59 and 60 to 69.
Arthritis rates were lowest among those who were not depressed (38.2%).
After controlling for age and gender, in addition to race, education, smoking status, binge drinking, and sedentary behavior, a significant association between clinical depression and arthritis persisted (OR, 1.24).
Further, after adjusting for the previous covariates plus obesity, diabetes, hypertension, and heart disease, clinical depression remained significantly associated with arthritis (OR, 1.21).
“This study highlights the importance of screening for and treating arthritis-related pain in older adults with depressive symptoms and the need for future geriatric psychiatry research on developing integrated biopsychosocial interventions for these common conditions,” the authors conclude.
Dr. Brooks said her group is currently working on “integrated non-pharmacological psychotherapy interventions” for the overlapping conditions.
Dr. Romilla Batra, Chief Medical Officer at SCAN Health Plan in Long Beach, California, commented, “The study puts a spotlight on the association of one of the most common causes of pain in older adults and depression.”
“Specifically focusing on arthritis is interesting because realistically it’s probably undertreated and underreported – it’s seen as a fact of life, an inevitable part of aging, so people don’t always report their pain,” she said in an email to Reuters Health. “Getting mental health providers to ask about pain makes great sense. Perhaps the most critical aspect is that they are acknowledging that medical and mental health conditions need to be treated together for the best outcomes.”
“The study wasn’t designed to show causality,” she noted, “and it also doesn’t clarify what type of arthritis they are talking about – there is a difference between osteoarthritis and inflammatory types like rheumatoid arthritis.”
“These diagnoses were self-reported, which introduces a level of uncertainty,” she added. “And, the depression definition was based on the PHQ-9. Many older adults have a type of depression that doesn’t quite meet the criteria, but may still affect mood and function.”
Dr. Michael J. Schrift, Chief of Geriatric and Neuro-psychiatry at Northwestern Memorial Hospital in Chicago, commented by email, “Studies show that when depression is co-occurring with arthritis and the depression is not being addressed, the treatment for arthritis itself can be less effective.”
“Both depression and arthritis affect the brain and the body and likely (have) a bidirectional association,” he told Reuters Health. “Inflammation in arthritis involves not only the affected joint, but also the brain. Also, changes in the brain affect one’s pain perception.”
Reference
- Brooks JM, Titus AJ, Polenick CA, et al. Prevalence rates of arthritis among US older adults with varying degrees of depression: Findingsfrom the 2011 to 2014 National Health and Nutrition Examination Survey. Int J Geriatr Psychiatry. 2018 Sep 19. [Epub ahead of print]
