Prevalence and Relevance of Depressive Symptoms in Patients with Rheumatic Diseases

Stefan Kleinert^1,2, Almuth Marx³, Hermann Faller⁴, Martin Feuchtenberger⁵, Christian Kneitz⁶, Stefanie Lehmann³, Hans Peter Tony⁷, Christiane Angermann^3,8, Georg Ertl⁸, Stefan Störk³ and Margret Breunig^3,9, ¹Rheumatologische Schwerpunktpraxis Erlangen, Erlangen, Germany, ²University Hospital Würzburg, Würzburg, Germany, ³Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany, ⁴Abteilung für Medizinische Psychologie und Psychotherapie, University of Würzburg, Würzburg, Germany, ⁵Rheumatologie/Klinische Immunologie, Kreiskliniken Altötting-Burghausen, Burghausen, Germany, ⁶Internal Medicine II, Hospital Südstadt, Rostock, Germany, ⁷Rheumatology / Clinical Immunology, University Hospital Würzburg, Würzburg, Germany, ⁸Dept. of Internal Medicine / Cardiology, University Hospital Würzburg, Würzburg, Germany, ⁹Dept. of Internal Medicine / Cardiology, University Hospital Würzburg, Würzburg, Wuerzburg, Germany

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Comorbidity, depression, morbidity and mortality and rheumatic disease

Session Information

Date: Sunday, November 8, 2015

Title: Epidemiology and Public Health Poster I: Comorbidities and Outcomes of Systemic Inflammatory Diseases

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

Patients with rheumatic diseases (RD) have an increased mortality risk compared to the normal population. The current prospective follow-up study investigated the prevalence of depressive symptoms and quality of life and their impact on prognosis.

Methods:

764 consecutive patients attending the rheumatology outpatient department of the University Hospital Würzburg underwent a comprehensive cardiovascular (CV) risk assessment. Quality of life and depressive symptoms were investigated by SF-36 and PHQ-9 (range 0-27 score points), respectively. A PHQ score >14 points is considered indicative for severe depressive symptoms. Patients were followed over 5 years for incident CV events and death of any cause.

Results:

352 subjects suffered from rheumatoid arthritis (RA: 79.5% female, 64.9% RF positive, mean age 54.3 (SD 14.3)), 260 from systemic autoimmune disease including connective tissue disease and vasculitis (SAI: 76.9 % female, mean age 51.4 (SD 14.5)), and 152 patients had spondyloarthritides including psoriatic arthritis (SpA: 35.5 % female, mean age 44.7 (SD 12.3)).

Severe depressive symptoms were prevalent in 7% (tab 1) of patients. There were no significant differences in the three groups regarding PHQ-9 subgroups (χ²-Test: p=0.214).

n (%)	PHQ9
	0-4 (minimal)	5-9 (mild)	10-14 (moderate)	15-27 (severe)
RA	154 (46.1)	110 (32.9)	48 (14.4)	22 (6.6)
SAI	109 (44.3)	85 (34.6)	35 (14.2)	17 (6.9)
SpA	54 (36.7)	47 (32)	34 (23.1)	12 (8.2)
total	317 (43.6)	242 (33.3)	117 (16.1)	51 (7.0)

Within 5 years, 18/10/0 patients died in the 3 groups (RA/SAI/SpA). Patients with severe depressive symptoms had a hazard ratio (HR) of 5.11 (95% CI 2.01–12.97) for death of any cause compared to the patients with less severe depressive symptoms. By contrast, the risk of CV events in the severe depressive group was similar compared with the other groups (p=0.73).

IMG1: Kaplan-Meier plot: Survival and CV events in PHQ-9 groups.

The 4 physical sections of SF-36 revealed an influence on the risk of death: HR for low tertile 3.95 (95% CI 1.67–9.31) if compared versus mid and high tertile combined. The 4 non-physical sections did confer prognostic information.

Conclusion:

RD patients with severe depressive symptoms as assessed by PHQ-9 exhibit an increased mortality risk, but not an increased risk for CV events.

Disclosure: S. Kleinert, None; A. Marx, None; H. Faller, None; M. Feuchtenberger, None; C. Kneitz, None; S. Lehmann, None; H. P. Tony, None; C. Angermann, None; G. Ertl, None; S. Störk, None; M. Breunig, None.

To cite this abstract in AMA style:

Kleinert S, Marx A, Faller H, Feuchtenberger M, Kneitz C, Lehmann S, Tony HP, Angermann C, Ertl G, Störk S, Breunig M. Prevalence and Relevance of Depressive Symptoms in Patients with Rheumatic Diseases [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/prevalence-and-relevance-of-depressive-symptoms-in-patients-with-rheumatic-diseases/. Accessed .

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