Stresses such as divorce or caring for a sick relative were significantly related to depression among arthritis patients in the study. Fifty-five percent of depressed patients reported having high levels of stress, compared with 31 percent of non-depressed patients.
But stresses that were clearly arthritis-related, like hospitalizations and time off work for ill health, were also more common among depressed patients, according to Chris Dickens, Ph.D., of the University of Manchester in the United Kingdom and colleagues.
"Our results partially support the assertion that disabling arthritis alone may lead to depressive symptoms, but definite depressive disorders appear to result from a combination of chronic social difficulties resulting from rheumatoid arthritis plus independent social stresses," Dickens says.
Anxiety and depressive disorders occur in 20 percent to 25 percent of rheumatoid arthritis patients, but it is not clear to what extent the chronic pain and disability of the disease contributes to these disorders, according to the researchers.
Previous studies have suggested a direct link between pain and depression in patients with the most severe arthritis cases. But Dickens and colleagues wondered if other factors, like social stress or loneliness, might contribute to depression in people with less advanced arthritis.
The researchers examined arthritic damage, disability, psychological well-being and social stresses among 74 women with various degrees of rheumatoid arthritis. Almost 40 percent of the women were diagnosed as having either definite or borderline depression or anxiety disorders.
Patients with borderline psychiatric disorders tended to have many arthritis-related stresses, while patients with definite disorders had the highest number of arthritis-related and independent stresses. Depressed patients were also significantly more likely to belong to a lower socioeconomic class, the researchers found.
The researchers found no significant link between depression and the severity of physical problems experienced by the patients.
The findings should lead to more appropriate depression treatments for rheumatoid arthritis patients that focus on factors beyond the disease, Dickens says.
The study is published in the May-June issue of the journal Psychosomatics.
FOR MORE INFORMATION
Health Behavior News Service: 202-387-2829 or www.hbns.org.
Interviews: Contact Chris Dickens at c.dicken@man.ac.uk.
Psychosomatics: Contact Tom Wise, M.D., at 703-698-3626.
Journal
Psychosomatics