Background/Purpose:   Depression rates are elevated among individuals with rheumatoid arthritis (RA).  Studies in cardiovascular disease and among elderly populations have found that depression is a risk factor for mortality, but the risk of mortality from depression in RA has received little attention.

Methods:   Data were derived from a longitudinal cohort study of individuals with RA recruited from community rheumatology practices and interviewed annually by telephone.  To be eligible for the current analysis, participants had to have an interview in either 2002 or 2003 and have at least one follow-up interview (n=530).  Subjects were followed until 2009. Cox regression models estimated the association of depression with the risk of all-cause mortality.  Depression was defined as a score ≥5 on the 15-item Geriatric Depression Scale (GDS). Using a time-dependent value, depression was defined as GDS≥5 in the last interview prior to death or censorship. In separate analyses we also examined the risk of a 2-point increase in GDS score from the penultimate to the last interview prior to death or censorship. Analyses controlled for age, gender, disease duration, and presence of any cardiovascular disease risk factors.  Separate analyses also examined the conjoint effects of gender and depression. 

Results:   Mean age (±SD) was 60 (±13), mean disease duration was 19 (±12) years, 84% were female, and 46% reported at least one cardiovascular risk factor. Subjects were followed for a mean of 4.9 (±1.6) years until death or censorship.  63 (12%) participants died during the follow-up period. In bivariate analyses, depression was associated with an increased risk of death (HR=3.5 [95% CI 2.1, 5.8]).  Worsening of GDS score by ≥2 points was also associated with an increased mortality risk (HR=2.5 [1.5, 4.2]).  Controlling for covariates, both depression and an increase in GDS remained significant predictors of mortality (see Table). Interaction models showed men with depression had 5 times the risk of death compared to women with no depression.  Men without depression also had a greater mortality risk than women with no depression after controlling for covariates.

Conclusion:   Depression and increase in depressive symptoms are significant risk factors for all-cause mortality in RA.  Men with either of these characteristics are particularly at risk. These findings provide additional evidence of the importance of identifying and treating depression among persons with RA.  Strategies to motivate men for treatment of depression are especially needed.

 

Table: Depression and increase of depression proximal to death as a risk factor for death among individual with RA
		Hazard Ratio (95% CI)
Model 1	Baseline GDS< 5	(referent)
	Baseline GDS≥5	2.3 (1.4, 3.9)
Model 2	GDS increase <  2 points	(referent)
	GDS increase ≥ 2 points	1.9 (1.1, 3.3)
Model 3	Baseline GDS  <5    Women (ref)	(referent)
	Baseline GDS  ≥ 5   Women	2.5 (1.4, 4.6)
	Baseline GDS < 5    Men	3.1 (1.4, 6.5)
	Baseline GDS  ≥5   Men	5.9 (2.7, 13.1)
Model 4	GDS increase <  2 points Women (ref)	(referent)
	GDS increase ≥  2 points Women	2.1 (1.1, 3.9)
	GDS increase <  2 points Men	3.0 (1.5, 6.0)
	GDS increase  ≥  2 points Men	5.1 (2.2, 11.8)
All models controlled for age, disease duration, cardiovascular disease risk factors. Models 1 and 2 also controlled for gender.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/depression-predicts-mortality-in-ra/