Background/Purpose:  A previously synthesized positive association between gout and depression has combined studies of both prevalent and incident depression. To disentangle these data and provide a comprehensive understanding of the burden, risk, impacts, and determinants of psychiatric complications in gout, our objective was to conduct a systematic review of observational studies of depression as well as anxiety among patients with gout.

Methods: We conducted a mapped search of Medline, Embase, and Cochrane Database of Systematic Reviews on the Ovid platform, and CINAHL Complete and PsycINFO on Ebscohost to identify full-length articles published in English meeting the following inclusion criteria: 1) observational design; 2) study sample including gout patients with or without a comparator group; 3) depression and/or anxiety evaluated as a comorbidity, outcome, or predictor of a health outcome and assessed using routinely reported measures; and 4) reporting of relevant estimates (e.g. prevalence proportion, odds ratio [OR], hazard ratio [HR]) or sufficient data to allow calculation. We extracted information on study setting and design, patient population and sample size, gout ascertainment, and methods of assessing depression and anxiety. Where relevant and sufficient data permitted, we pooled estimates using random effects models.

Results: From 771 articles identified with our search strategy, we included 16 studies with 9 assessing both depression and anxiety and 7 assessing depression alone.  With respect to depression, the pooled prevalence proportion based on 8 studies and a total of 57,103 gout patients was 10% (95% confidence interval [CI], 8% to 12%) and pooled OR was 1.19 (95% CI, 1.03 to 1.35). The incidence of depression in gout patients as compared to the general population was reported in 3 studies and meta-analysis yielded a pooled adjusted (a)HR of 1.09 (95% CI, 0.93 to 1.26). With respect to anxiety, pooled prevalence proportion based on 5 studies and a total of 36,708 gout patients was 6% (95% CI, 3% to 10%) and pooled OR was 1.54 (95% CI, 1.43 to 1.65). Only 1 study assessed the incidence of anxiety among gout patients (aHR, 1.01; 95% CI, 0.87 to 1.16).  Determinants of psychiatric complications include a higher frequency of gout attacks, having oligo/polyarticular gout, greater number of tophi, disability, quality of life, and education level (anxiety only). Finally, both depression and anxiety in gout significantly impact patients’ health-related quality of life.

Conclusion: Our findings establish a substantial prevalence of both depression and anxiety among gout patients. This highlights the need for further research to better understand the onset (incidence) of psychiatric complications after gout diagnosis as well as identify potential targets for intervention.