Depression and inflammatory arthritis are associated in both Western and Non-Western countries: Findings from the World Health Survey 2002

Association of improvement and worsening of depressive symptoms with arthritis

PURPOSE

The longitudinal association between changes in depressive symptoms (improvement/worsening) and arthritis is unclear.

METHODS

Study data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018. The 10-item Center for Epidemiological Studies Depression Scale (CES-D-10) was used to examine participant depressive symptoms and data on self-reported history of arthritis were collected. Depressive symptoms improving is defined as depression at baseline and no depression at follow-up. Similarly, depressive symptoms worsening is defined as no depression at baseline and depression at follow-up. Cox proportional hazards models were used to evaluate the effects of improvement or deterioration in depressive symptoms on arthritis. Participants with missing data on depression and arthritis, having arthritis in 2011 CHARLS and lost to follow-up was excluded.

RESULTS

A total of 8556 participants free of arthritis were included from 2011 to 2018. After adjustment for confounders, depressive symptoms were associated with a 54% increased risk of developing arthritis. Each 1-point increase in CES-D-10 score was associated with a 4% higher risk of arthritis. Participants with depressive symptoms at baseline but improved symptoms (without depressive symptoms) at follow-up had a 25% lower rate of arthritis, and a 1-point reduction in CES-D-10 score during 8 years of follow-up was associated with a 5% lower risk of developing arthritis. Participants with no depressive symptoms at baseline but depression at follow-up had a 66% higher rate of arthritis, and a 1-point increase in CES-D-10 score during 8 years of follow-up was associated with a 5% higher risk of arthritis.

CONCLUSIONS

Improvement in depressive symptoms was associated with lower risk of arthritis and worsening of depression was associated with higher risk of arthritis. These findings suggest that the relationship between depression and arthritis is complex.

The burden of depressive disorders in musculoskeletal diseases: is there an association between mood and inflammation?

IMPORTANCE

Evidence emerged concerning how inflammatory arthritis and mood disorders can often occur in the same patient and show a similar clinical pattern. An overview of the rheumatological and psychiatric aspects of these diseases can certainly be useful for the improvement of patients' clinical and therapeutic management.

OBJECTIVE

The aim of this narrative review was to summarize existing literature about common pathogenetic and clinical aspects as a means of improving management and therapeutic approach in patients affected by rheumatoid arthritis, psoriatic arthritis and spondyloarthritis. Outcomes such as disease activity indexes and patient reported outcomes (PROs) were considered.

FINDINGS

Common pathogenetic pathways emerged between inflammatory arthritis and mood disorders. Pro-inflammatory mechanisms, such as TNFα, IL-6, IL-17 and oxidative stress factors as well as neurotransmitter alterations at the level of CNS and blood-brain barrier (BBB) cells are involved. The activation of these common pathogenetic pathways is, also, affected by the same triggers, such as smoking, stress, lifestyle, and evidence has emerged concerning the possibility of the clinical efficacy of using the same therapeutic approaches.

CONCLUSIONS

The main causes of the variability in clinical studies outcomes are the rheumatological diseases considered, the prevalence of depression in the general population and in patients with rheumatological diseases and the type of depressive symptom examined. Patients affected by inflammatory arthritis can present symptoms and signs in common with mood disorders, leading to possible clinical overlap. There are still few studies analyzing this concept: they are extremely heterogeneous, both in the characteristics of the population taken into consideration and in the methods used for the definition of depressive disorder, but the suggestions of the data obtained so far are promising and deserve to be pursued.

Inequalities in health and health risk factors in the Southern African Development Community: evidence from World Health Surveys

Background

Socioeconomic inequalities in health have been documented in many countries including those in the Southern African Development Community (SADC). However, a comprehensive assessment of health inequalities and inequalities in the distribution of health risk factors is scarce. This study specifically investigates inequalities both in poor self-assessed health (SAH) and in the distribution of selected risk factors of ill-health among the adult populations in six SADC countries.

Methods

Data come from the 2002/04 World Health Survey (WHS) using six SADC countries (Malawi, Mauritius, South Africa, Swaziland, Zambia and Zimbabwe) where the WHS was conducted. Poor SAH is reporting bad or very bad health status. Risk factors such as smoking, heavy drinking, low fruit and vegetable consumption and physical inactivity were considered. Other environmental factors were also considered. Socioeconomic status was assessed using household expenditures. Standardised and normalised concentration indices (CIs) were used to assess socioeconomic inequalities. A positive (negative) concentration index means a pro-rich (pro-poor) distribution where the variable is reported more among the rich (poor).

Results

Generally, a pro-poor socioeconomic inequality exists in poor SAH in the six countries. However, this is only significant for South Africa (CI = − 0.0573; p < 0.05), and marginally significant for Zambia (CI = − 0.0341; P < 0.1) and Zimbabwe (CI = − 0.0357; p < 0.1). Smoking and inadequate fruit and vegetable consumption were significantly concentrated among the poor. Similarly, the use of biomass energy, unimproved water and sanitation were significantly concentrated among the poor. However, inequalities in heavy drinking and physical inactivity are mixed. Overall, a positive relationship exists between inequalities in ill-health and inequalities in risk factors of ill-health.

Conclusion

There is a need for concerted efforts to tackle the significant socioeconomic inequalities in ill-health and health risk factors in the region. Because some of the determinants of ill-health lie outside the health sector, inter-sectoral action is required.

The association of self-reported diabetes with impaired social functioning in low-, middle- and high-income countries: findings from the World Health Survey

AIM

Epidemiological studies from high-income countries show that diabetes is associated with impaired social functioning. As healthcare systems in middle- and low-income countries offer fewer resources to curtail the potential social impact of diabetes, we performed a comparative study on the diabetes-social impairment link in low-, middle- and high-income countries.

METHODS

We use data from the cross-sectional World Health Survey (n = 235 428 from 10 low-income, 29 middle-income and 9 high-income countries). Diabetes was defined by self-reports of a diagnosis. Impaired social functioning was considered present if participants reported severe or extreme difficulties with personal relationships or participation in the community. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) in the overall sample and by income regions. ORs were corrected for demographics and health-related lifestyles, and then additionally adjusted for impairments that may explain any observed association (i.e. impaired vision, mood, cognition and mobility).

RESULTS

In the overall sample, we confirmed an association between self-reported diabetes and impaired social functioning (OR = 1.47, 95% CI = 1.18-1.83). The strength of that relationship increased with decreasing country income (e.g. OR in low-income countries = 2.23, 95% CI = 1.14-4.37). Associations were substantially attenuated by further correction for impairments, in particular mood problems, in the overall sample (OR = 0.92, 95% CI = 0.72-1.16) and all income regions.

CONCLUSIONS

Self-reported diabetes is associated with impaired social functioning in high- and middle-income countries, and this relationship is even stronger in low-income countries. Associations are largely explained by physical and mental impairments, which may be due to diabetes.

Reports of wheezing and of diagnosed asthma are associated with impaired social functioning: Secondary analysis of the cross-sectional World Health Survey data

OBJECTIVE

We sought to investigate whether there are associations between asthma and social functioning in adults from Western and non-Western countries.

METHODS

We analyzed data on individuals (94% aged 20+, 52% female) from 50 countries participating in the cross-sectional World Health Survey. We used information on self-reports of wheezing and an asthma diagnosis. Social functioning was defined by reports of severe or extreme difficulties related to personal relationships or participation in the community. Logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Wheezing was associated with impaired social functioning both in the overall sample (OR=2.40, 95%CI=2.09-2.75) and in Africa, South America and Asia (ORs≥2.47), but not in Europe (aOR=1.26, 95%CI=0.90-1.77). Analyses with self-reports of diagnosed asthma yielded similar, albeit weaker, associations (e.g. OR for the overall sample=1.63, 95%CI=1.38-1.92). We also combined asthma and wheezing into a single variable (reference group: no asthma diagnosis/no wheezing). We observed that in particular reports of wheezing were associated with impaired social functioning regardless of whether a concomitant asthma diagnosis was reported (OR=2.19, 95%CI=1.81-2.64) or not (OR=2.50, 95%CI=2.09-2.99).

CONCLUSION

Self-reports of wheezing and of diagnosed asthma are associated with impaired social functioning among adults in Africa, South America and Asia, but less so in Europe. These relationships are mainly driven by the experience of respiratory symptoms (i.e. wheezing). Our findings may partly be explained by regional variations in asthma control. Further research should elucidate the determinants and mechanisms of asthma-related impaired social functioning.