Impact of clinical and psychological factors associated with depression in patients with rheumatoid arthritis: comparati
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ORIGINAL ARTICLE
Impact of clinical and psychological factors associated with depression in patients with rheumatoid arthritis: comparative study between Germany and Brazil Harriet Morf 1,2 Olga Seifert 4,2
&
Geraldo da Rocha Castelar-Pinheiro 3,2 & Ana Beatriz Vargas-Santos 3,2 & Christoph Baerwald 4,2 &
Received: 29 June 2020 / Revised: 8 October 2020 / Accepted: 15 October 2020 # The Author(s) 2020
Abstract Objective To investigate the prevalence of depressive symptoms and its association with clinical and psychological factors in patients with rheumatoid arthritis (RA) in Germany and in Brazil. Method A convenience sample of 267 RA patients, 176 from Germany (age 62.4 ± 12.3 years) and 91 from Brazil (age 56.3 ± 12.6 years), was used in this cross-sectional study. The following questionnaires were used: Beck Depression Inventory (BDI), painDETECT test, Perceived Stress Questionnaire, fatigue questionnaire (FACIT), Health Assessment Questionnaire Disability Index (HAQ-DI), and the SF–36 questionnaires (Short-Form 36 Health Survey). Disease activity score (DAS 28-CRP) and visual analogue scale (VAS) for pain were also evaluated. Statistical analysis is based on comparison of means and proportions. Statistical significance for non-normal data was evaluated by non-parametrical tests. Results Depressive symptoms were more prevalent in the Brazilian sample (44% vs 22.9%, p = 0.025). Compared to German patients, the Brazilian ones also experienced more pain (current pain status on VAS: 4.67 ± 3.4 vs 3.67 ± 2.31 respectively, p < 0.01), were physically more limited (1.89 ± 1.85 vs 1.01 ± 0.75, p = 0.012), and had higher C-reactive protein levels (7.78 ± 18.3 vs 5.82 ± 10.45, p = 0.028). Despite receiving a more intensive treatment, German patients presented similar disease activity when compared to Brazilian patients (DAS28-CRP: Brazil 3.4 ± 1.5 vs Germany 3.3 ± 1.3, p = 0.307). Conclusion Depressive symptoms are frequent in RA patients from different countries and interact with psychological disorders and the experience of pain. They contribute negatively to their well-being suggesting the need for psychoeducational strategies. Key Points • New psychoeducational strategies for RA management. • Higher inflammation marker in rheumatoid arthritis patients is associated with depression. • Medical treatment in RA influences depressive symptoms. • Depressive symptoms are dependent on population group. • High disease activity is related to depression.
* Harriet Morf [email protected]
1
Department of Rheumatology, University Hospital Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
2
Department of Internal Medicine 3 and Institute for Clinical Immunology, University Hospital Erlangen, Maximilianspl. 2, 91054 Erlangen, Germany
3
Department of Internal Medicine, Rheumatology Unit, Universidade do Estado do Rio de Janeiro, R. São Francisco Xavier, 524-Maracanã, Rio de Janeiro, Brazil
4
Department of Rheumatology, University Hospital Leipzig, Liebigstraße 20, 04104 Leipzig, Germany
Geraldo da Rocha Castelar
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