Depressive Symptoms and the Arthritis-Employment Interface: A Population-Level Study

Double Trouble! Do Workplace Supports Mitigate Lost Productivity for Young Workers with Both Severe Rheumatic Diseases and Depressive Symptoms?

BACKGROUND

The objectives of this longitudinal study were to understand how comorbid rheumatic disease and depression symptoms were associated with at-work productivity among young adults, and to examine whether workplace support modified this association.

METHODS

Seventy-six Canadian young adults who were employed and living with a rheumatic disease were surveyed three times over 27 months. Morbidity was defined by whether participants reported severe rheumatic disease symptoms and/or depressive symptoms. Participants were asked about presenteeism, absenteeism, and whether the workplace support needs (accommodation and benefit availability and use) were met. Generalized estimating equations were used to address study objectives.

RESULTS

Seventeen participants experienced neither severe rheumatic disease nor depressive symptoms (no morbidity), 42 participants experienced either severe rheumatic disease or depressive symptoms (single morbidity), and 17 participants reported comorbidity at baseline. Participants with comorbidity reported greater presenteeism scores and were most likely to report absenteeism, compared to the other two morbidity levels. Having workplace support needs met was associated with decreased presenteeism over the 27-month period among participants with no and a single morbidity. Conversely, unmet support need was associated with greater presenteeism for participants with comorbidity. Having workplace support needs met did not modify the association between morbidity and absenteeism.

CONCLUSION

Comorbid rheumatic disease and depression burden reduce productivity among young adults. A supportive work environment has the potential to address at-work productivity challenges. Additional research is needed to understand how workplace supports coupled with clinical interventions may tackle challenges at work for young adults living with rheumatic disease and depression.

Prevalence and associated factors for depressive symptoms among the general population from 31 provinces in China: The utility of social determinants of health theory

BACKGROUND

Depression is one of the most common types of mental disorders. Guided by the theory of social determinants of health (SDH), the study aimed to assess the prevalence of depressive symptoms and to identify factors related to depressive symptoms in the general population of China.

METHODS

A cross-sectional, online survey was conducted among 101,392 residents from 31 provinces of mainland China from January to March 2019, and 97,126 survey responses were included in the final analysis. Multilevel linear regression models were used to identify SDH associated with depressive symptoms.

RESULTS

The prevalence of depressive symptoms (PHQ-9 scores ≥10) in Chinese residents was 15.81 %. The results of the multilevel analysis demonstrated that depressive symptoms were affected by various factors on five levels, including individual characteristics, behavioral lifestyle, community support network, social structural factors, and macro social factors.

LIMITATIONS

The cross-sectional design of the study makes it difficult to establish causality between variables.

CONCLUSIONS

The prevalence of depressive symptoms is high among general population in China. According to the theory of SDH, the study shows that the depressive symptoms are complex and involves all areas of social life. Therefore, adopting a multi-level, cross-sectoral intervention approach will be instrumental to improving the mental health of residents in China.

Researchers in rheumatology should avoid categorization of continuous predictor variables

BACKGROUND

Rheumatology researchers often categorize continuous predictor variables. We aimed to show how this practice may alter results from observational studies in rheumatology.

METHODS

We conducted and compared the results of two analyses of the association between our predictor variable (percentage change in body mass index [BMI] from baseline to four years) and two outcome variable domains of structure and pain in knee and hip osteoarthritis. These two outcome variable domains covered 26 different outcomes for knee and hip combined. In the first analysis (categorical analysis), percentage change in BMI was categorized as ≥ 5% decrease in BMI, < 5% change in BMI, and ≥ 5% increase in BMI, while in the second analysis (continuous analysis), it was left as a continuous variable. In both analyses (categorical and continuous), we used generalized estimating equations with a logistic link function to investigate the association between the percentage change in BMI and the outcomes.

RESULTS

For eight of the 26 investigated outcomes (31%), the results from the categorical analyses were different from the results from the continuous analyses. These differences were of three types: 1) for six of these eight outcomes, while the continuous analyses revealed associations in both directions (i.e., a decrease in BMI had one effect, while an increase in BMI had the opposite effect), the categorical analyses showed associations only in one direction of BMI change, not both; 2) for another one of these eight outcomes, the categorical analyses suggested an association with change in BMI, while this association was not shown in the continuous analyses (this is potentially a false positive association); 3) for the last of the eight outcomes, the continuous analyses suggested an association of change in BMI, while this association was not shown in the categorical analyses (this is potentially a false negative association).

CONCLUSIONS

Categorization of continuous predictor variables alters the results of analyses and could lead to different conclusions; therefore, researchers in rheumatology should avoid it.

Associations of Rheumatoid Arthritis and Depressive Symptoms Over Time: Are There Differences by Education, Race/Ethnicity, and Gender?

OBJECTIVE

To examine associations between changes in rheumatoid arthritis (RA) symptoms and depressive symptoms adjusted for other time-varying characteristics, and to test if these associations differed by education, race/ethnicity, or gender.

METHODS

Data from the 1988-1998 US National Rheumatoid Arthritis Study were analyzed (n = 854). Time-varying covariates included year of the study, pain, functional ability, household work disability, parental status, marital status, employment status, and social support. The time-invariant covariates included years since diagnosis, education, race/ethnicity, and gender. Multivariate multilevel-model analyses were used to estimate associations within people over time.

RESULTS

Patients with RA experience considerable change in depressive symptoms, pain, functional disability, and household work disability over the study period. Depressive symptoms were driven more by differences between people compared to changes within people over time. Findings show that patients experienced increases in depressive symptoms over the study period. The rate of change in depressive symptoms did not differ by education, race/ethnicity, or gender. Times of worse pain, functional disability, and household disability were associated with worse depressive symptoms. The association of functional disability and depressive symptoms was stronger for men than women.

CONCLUSION

Increases in pain and disability were associated with worse depressive symptoms, adjusted for covariates. It is important to monitor and treat both mental and physical health symptoms. Future research efforts should focus on collecting data reflecting the educational, gender, and racial/ethnic diversity of individuals with RA.

A Systematic Review of Nutritional Interventions on Key Cytokine Pathways in Rheumatoid Arthritis and Its Implications for Comorbid Depression: Is a More Comprehensive Approach Required?

Rheumatoid arthritis (RA) is associated with both local and systemic inflammatory processes via the aberrant regulation of inflammatory pathways and imbalances in several mediators of inflammation. Cytokines, tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1B, IL-6, IL-17, IL-18, rheumatoid factor, anti-cyclic citrullinated protein, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) have been used in diagnosing and tracking the progression of RA. The primary objective of this review is to identify and summarize which specific dietary patterns and nutritional interventions go beyond symptom management to improve the response to known inflammatory cytokines and possibly decrease markers of inflammation in the RA disease process. Analysis of the 41 identified publications demonstrated that certain dietary patterns, the consumption of specific macronutrients, and supplementation with herbals or other compounds have shown some effect on improving cytokine profiles in patients with RA.

This review illustrates the importance of proper patient education on the anti-inflammatory and potential protective impacts substantial dietary change may have on the disease progression and symptoms of RA. Identifying nutritional interventions and dietary patterns that improve the inflammatory cytokine profile, and therefore disease progression and inflammatory comorbidities of RA will help further focus research on treatments that may provide a better overall improvement in quality of life for RA patients by focusing on the root cause inflammatory processes that affect not only joint destruction but also depression-rated disability. This review further notes that while depression is commonly found in patients who suffer from chronic illnesses, it is especially prevalent in the RA population. The pathology of depression is associated with systemic inflammation, which is a known outcome of RA and may explain this strong association. Cytokines IL-6, IL-1, and TNF-α, known mediators involved in the progression of RA, are strongly associated with stress-related disorders including depression and anxiety. The presence of these cytokines is also correlated with the severity and duration of depression. This may signal a potential use of cytokines in diagnosing and following the progression of depression not only in patients with RA but also others. Given the statistics presented on depression and suicide in patients with RA, and the shared inflammatory pathway between the two diseases, depression and suicide screening scales should be included along with analysis of inflammatory markers and disease activity scores (DAS) in any future RA study.

Beyond the hand and upper extremity: The role of hand therapists in care of people with rheumatic diseases

STUDY DESIGN

Invited Clinical Commentary BACKGROUND: Arthritis is one of the most frequently reported causes of disability in the United States and the prevalence is expected to increase in the coming decades. While many rheumatic diseases involve hand impairments, most are systemic and involve more than the musculoskeletal system. Functional and work disability are high and people would benefit from the services of occupational and physical therapists.

PURPOSE OF STUDY

This paper reviews concepts of self-management, and symptoms that contribute to limitations and restrictions to participation in daily life in people with rheumatic diseases and suggests roles for hand therapists beyond the immediate hand impairments.

METHODS

The impact of selected rheumatic diseases on functional and work disability are reviewed along with strategies for symptom management and self-management. Upper extremity impairments of selected rheumatic diseases are also discussed.

RESULTS

The role for hand therapists in evaluating and addressing the complex needs of persons with rheumatic diseases, including less common diseases, is discussed. Outcome measures for fatigue, muscle involvement, ergonomics and computer use, and work disability are introduced. Finally, strategies for self-management and prevention of work and functional disability, along with symptom management for fatigue and pain are presented.

CONCLUSION

Hand therapists can play a vital role in chronic rheumatic disease management to improve self-management and increase participation in meaningful activities. Patients, primary care and rheumatology providers need to be educated about the scope of services occupational and physical therapists provide beyond the hand impairments.