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Abstract Number: 1006

Sex Differences in Depressive Symptom Subtypes in Knee Osteoarthritis

Alan Rathbun1, Megan Schuler2, Elizabeth Stuart3, Michelle Shardell4, Michelle S. Yau5 and Marc Hochberg6, 1Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, 2Rand Coportation, Boston, MA, 3Mental Health, Biostatistics, and Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 4Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, 5Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, 6Department of Medicine, University of Maryland School of Medicine, Baltimore, MD

Meeting: ACR/ARHP Annual Meeting 2017

Date of first publication: September 18, 2017

Keywords: ,

Session Information

Date: Monday, November 6, 2017

Title: ARHP Epidemiology and Public Health Poster

Session Type: ACR Poster Session B

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

Background/Purpose: Knee osteoarthritis (OA) is characterized by structural changes in subchondral bone and degradation of articular cartilage, but the pathology does not necessarily lead to pain and functional limitations. Latent and modifiable factors, such as depression, may contribute to or worsen knee OA symptoms. However, depression is clinically heterogeneous and presentation may manifest differently by subtypes and by sex. The objectives were to identify depressive symptom subtypes, examine sex differences across subtypes, and evaluate clinical correlates.   Methods: Eligible participants (n=4490) were enrolled in the Osteoarthritis Initiative (OAI) and had or were at risk for symptomatic knee OA. Latent class analysis was applied to symptomology measured by the 20-Item Center for Epidemiological Studies Depression Scale to identify homogenous subtypes with similar patterns of depressive symptoms at study enrollment. Subtype prevalence and item-response probabilities, an indicator of severity within subtype, were estimated separately in men and women. Posterior probability estimates were used to assign each participant to the subgroup for which he or she had the highest probability of membership. Clinical characteristics, including body mass index (BMI), Charlson comorbidity, gait speed, analgesic use, pain severity, and radiographic evidence of knee OA (Kellgren-Lawrence grade ≥ 2), were compared across subtypes by sex.   Results: Four depressive symptom subtypes were identified: “No Symptoms,” “Moderate,” “Moderate-Melancholic,” and “Severe.” Item-response probabilities and prevalence estimates significantly differed by sex (P = <0.001). “No Symptoms” was more common in men (79.8%) than women (77.5%) and had low item-response probabilities across all symptoms. “Moderate” was characterized by sadness and anhedonia and occurred more frequently in men (12.2%) than women (11.2%); however, item-response probabilities were higher in women, indicating greater severity. “Moderate-Melancholic” and “Severe” were differentiated from other subtypes by fatigue, loss of appetite, and insomnia and were more common in women (7.0% and 4.2%, respectively) than men (6.4% and 1.7%, respectively); yet, item-response probabilities were higher in men, suggesting greater severity. Comorbidity scores, gait speed, pain scores, and analgesic use were significantly associated with subtype membership among both sexes; radiographic evidence of knee OA was only significant in men, while BMI was only significant in women (Table 1).   Conclusion: Study findings indicate the presence of four distinct depressive symptom subtypes that differ in prevalence and clinical presentation by sex among persons who have or are at risk for symptomatic knee OA. Understanding variation in concurrent depressive symptoms among knee OA patients will help inform tailored treatment strategies.                  

Table 1. Baseline clinical characteristics among men and women enrolled in the Osteoarthritis Initiative by depressive symptom subtype (N=4490).

Men (n=1881)

Variable
(n % or mean sd)

No Symptoms
(n=1540)

Moderate
(n=208)

Moderate-Melancholic
(n=103)

Severe
(n=30)

P Value

BMI

28.75

4.07

28.93

4.26

29.38

4.00

28.46

5.24

0.429

Charlson Comorbidity

0.39

0.89

0.52

1.03

0.47

0.85

0.79

1.35

0.025

Gait Speed

1.37

0.20

1.31

0.22

1.31

0.24

1.3

0.22

<0.001

Analgesic Use

406

26.50

58

27.90

44

42.70

57

57.10

<0.001

WOMAC Pain

1.86

2.70

2.62

3.70

3.99

3.77

3.6

3.92

<0.001

K-L Grade ≥ 2

613

39.80

98

47.10

58

56.30

15

50.00

0.002

Women (n=2609)

Variable
(n % or mean sd)

No Symptoms
(n=2086)

Moderate
(n=268)

Moderate-Melancholic
(n=145)

Severe
(n=110)

P Value

BMI

28.14

5.07

29.37

5.63

29.57

6.04

30.39

6.15

<0.001

Charlson Comorbidity

0.31

0.68

0.55

1.07

0.60

1.13

0.68

0.94

<0.001

Gait Speed

1.32

0.21

1.25

0.21

1.21

0.26

1.18

0.22

<0.001

Analgesic Use

667

32.00

96.00

36.00

64

44.40

58

52.70

<0.001

WOMAC Pain

2.16

2.99

3.25

3.88

3.87

4.51

4.43

4.63

<0.001

K-L Grade ≥ 2

897

43.00

132

49.30

73

50.30

51

46.40

0.093

BMI, body mass index; K-L, Kellgren-Lawrence; SD, standard deviation; WOMAC, Western Ontario & McMaster Universities Osteoarthritis Index.

     
Disclosure: A. Rathbun, None; M. Schuler, RAND, 3; E. Stuart, None; M. Shardell, None; M. S. Yau, None; M. Hochberg, None.

To cite this abstract in AMA style:

Rathbun A, Schuler M, Stuart E, Shardell M, Yau MS, Hochberg M. Sex Differences in Depressive Symptom Subtypes in Knee Osteoarthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/sex-differences-in-depressive-symptom-subtypes-in-knee-osteoarthritis/. Accessed .

ACR Meeting Abstracts - https://acrabstracts.org/abstract/sex-differences-in-depressive-symptom-subtypes-in-knee-osteoarthritis/