February 1, 2008
Patients with rheumatoid arthritis, the most common chronic inflammatory arthritis, are twice as likely as individuals without rheumatoid arthritis to experience depression but aren’t likely to talk to a doctor about it, according to researchers at the University of North Carolina at Chapel Hill.
In a study published in the February issue of Arthritis Care & Research, researchers found that patients whose activities were more restricted due to their arthritis were more than twice as likely to have moderately severe to severe symptoms of depression. They also found that not many depressed patients discussed their condition with their rheumatologists, and, if they did, the subject was always brought up by the patients as opposed to the physicians.
Betsy Sleath, PhD, a professor at the UNC School of Pharmacy, led the study. She said that although depression in primary care has been well studied, no previous studies have examined whether rheumatologists and RA patients discuss depression during medical visits.
“Chronic diseases can greatly affect a person’s mental health,” Sleath said. “Since many arthritis patients see their rheumatologist more often then their primary-care physician, we recommend that rheumatologists take steps to screen patients for signs of depression.”
Rheumatologists should consider addressing both RA and depression when they see their patients, Sleath said. If physicians are uncomfortable discussing depression with their patients, they should consider having their office staff administer a brief depression screening before the patients’ visits in order to identify problems early on.
“When patients visit their rheumatologists, their main focus is understandably their arthritis,” Sleath said. “Chronic diseases can greatly affect a patient’s psychosocial well-being, and depression can also affect a patient’s adherence to treatment regimens.”
The study included 200 arthritis patients from four rheumatology clinics with eight participating doctors. Patient visits were audiotaped, and patients were interviewed after their medical visits using a questionnaire to assess depressive symptoms.
The results showed that almost 11 percent of the patients in the study had moderately severe to severe symptoms of depression. Those who were rated as being more restricted in their normal activities were significantly more likely to have these symptoms.
Only one in five of the patients who showed symptoms discussed depression with their rheumatologists. Those who did were always the ones to bring up the topic, not the physician. When depression was brought up, it was often not discussed at any length, Sleath said.
In addition to screening for depression, Sleath said it is important for patients to have access to appropriate treatment. Rheumatologists can treat the depression themselves, refer patients to a mental health professional, or communicate with the patient’s primary-care physician to coordinate a treatment plan. Also, given how common depression is in these patients, rheumatology training programs should educate physicians about the importance of screening for and treating depression, she said.
The study was titled “Communication about Depression during Rheumatoid Arthritis Patient Visits.” The other authors of the study are Betty Chewning, PhD, of the University of Wisconsin; Brenda M. De Vellis, PhD, and Robert F. De Vellis, PhD, of the UNC Cecil G. Sheps Center for Health Services Research; Gail Tudor, PhD, and Morris Weinberger, PhD, of the UNC School of Public Health; and Ashley Beard, a PhD candidate at the UNC School of Pharmacy.
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