Depression and anxiety correlate with disease-related characteristics and quality of life in Chinese patients with gout: a case-control study

Development and validation of a prediction nomogram for depressive symptoms in gout patients

Objective

The objective of the study was to explore the risk factors for depressive symptoms in patients with gout and to construct and validate a nomogram model.

Methods

From October 2022 to July 2023, a total of 469 gout patients from a Class iii Grade A hospital in Northeast China were selected as the research objects by the convenience sampling method. The General Information Questionnaire, Self-Rating Depression Scale, Gout Knowledge Questionnaire, Self-Efficacy Scale for Managing Chronic Disease (SEMCD), and Social Support Rating Scale were used to conduct the survey. Univariate and multivariate logistic regression analyses were used to establish a depression risk prediction model and construct a nomogram. The bootstrap method was used to verify the performance of the model.

Results

The detection rate of depressive symptoms in gout patients was 25.16%. Binary logistic regression analysis showed that male, the number of tophi, acute attack period, lack of knowledge about gout, the number of attacks in the past year, and the duration of the last attack were independent risk factors for post-gout depression. Female, interictal period, chronic arthritis period, knowledge of gout, and social support were protective factors for post-gout depression (p < 0.05). The calibration (χ2 = 11.348, p = 0.183, p > 0.05) and discrimination (AUC = 0.858, 95%CI: 0.818-0.897) of the nomogram model for depressive symptoms in gout patients were good.

Conclusion

The prevalence of depressive symptoms in gout patients is high, and it is affected by gender, current disease stage, number of tophi, gout knowledge level, the number of attacks in the past year, and the last attack days. The nomogram model is scientific and practical for predicting the occurrence of depressive symptoms in gout patients.

Urate-lowering therapy adherence and the association with medication beliefs, self-efficacy, depression, anxiety, and COVID-19 pandemic-related concern in Chinese gout patients: a cross-sectional study

This study aims to assess urate-lowering therapy adherence and the relationship with medication beliefs, self-efficacy, depression, anxiety, and COVID-19 pandemic-related concerns in Chinese gout patients during the COVID-19 outbreak. 101 gout patients receiving urate-lowering therapy were involved to evaluate adherence, medication beliefs, self-efficacy, depression, anxiety, and COVID-19 pandemic-related concerns via a mobile app-based questionnaire. Statistical analysis was performed using SPSS 22.0. A total of 101 valid responses were included in the statistical analysis. The results showed that, the rate of adherence to urate-lowering therapy during the COVID-19 outbreak was 22.8% in Chinese patients with gout, higher than that in normal times (9.6%). Compared to the adherent group, non-adherent gout patients had shorter disease duration, lower self-efficacy, lower necessity about urate-lowering therapy score, higher concerns about urate-lowering therapy score, and smaller necessity-concerns differential. Depression and anxiety rates (3.0% and 5.0%, respectively) during the COVID-19 break were lower than that in normal times. Additionally, depression, anxiety, as well as COVID-19 pandemic-related concerns (27.7%) were not related to urate-lowering therapy adherence. In conclusion, adherence rate to urate-lowering therapy in Chinese gout patients during the COVID-19 outbreak was 22.8%, higher than normal times, but still very poor. Except for a little concern about being more susceptible to the virus, patients' mental state is relatively good. While the country puts great efforts into COVID-19 prevention and control, attention must also be paid to the medication management of patients with chronic diseases such as gout.

Associations between depressive symptoms, anxiety symptoms, their comorbidity and health-related quality of life: a large-scale cross-sectional study

Background

There were few studies exploring the associations between depressive symptoms, anxiety symptoms and health-related quality of life (HRQoL) in the general population, especially in resource limited area. The aims of this study were to assess the associations between depressive symptoms, anxiety symptoms, their comorbidity and HRQoL in rural area.

Methods

A total of 23,496 eligible participants from Henan rural cohort were included. The Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) were employed to assess depressive and anxiety symptoms, respectively. HRQoL was measured via European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L). Tobit regression and generalized linear model were utilized to explore the associations between depressive symptoms, anxiety symptoms, their comorbidity and HRQoL.

Results

A total of 1320 individuals were identified as depressive symptoms with a prevalence rate of 5.62%, while 1198 participants were classified as anxiety symptoms with a prevalence rate of 5.10%. After multiple adjustment, the regression coefficients (β) and 95% confidence interval (CI) of utility index for depressive and anxiety symptoms were − 0.166 (− 0.182, − 0.149) and − 0.132 (− 0.149, − 0.114), respectively. The β and 95% CI of VAS score for depressive and anxiety symptoms were − 7.65 (− 8.60, − 6.70) and − 5.79 (− 6.78, − 4.80), respectively. Additionally, the comorbidity was strongly associated with low utility index and VAS score. These findings were observed robustly in men and women.

Conclusion

Depressive symptoms, anxiety symptoms and their comorbidity were associated with low HRQoL in rural population, which needed further efforts on preventive and treatment interventions.

Clinical trial registration

The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 06 July, 2015.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11969-1.

Epidemiology of Depression and Anxiety in Gout: A Systematic Review and Metaanalysis

OBJECTIVE

To conduct a systematic review of depression and anxiety among patients with gout that specifically evaluates the prevalence, incidence, determinants, and effects of these mental health comorbidities.

METHODS

We conducted a literature search in Medline, Embase, Cochrane Database of Systematic Reviews, CINAHL, and PsycINFO using indexed terms and key words to identify studies reporting on depression/anxiety in patients with gout. This review included full-text articles published in English that reported on patients with gout, evaluated depression/anxiety using a routinely reported measure, and provided estimates or sufficient data on the prevalence, incidence, determinants, or effects of depression/anxiety. Metaanalyses were conducted using random effects models.

RESULTS

Twenty of 901 articles identified through the search strategy met our inclusion criteria. All 20 studies evaluated depression, while only 10 assessed anxiety (50%). Metaanalyses suggest a positive association between mental health disorders and gout, as resultant pooled OR were 1.29 (95% CI 1.07-1.56) for depression and 1.29 (95% CI 0.96-1.73) for anxiety. Findings from four studies reporting on the incidence of depression in patients with gout resulted in a pooled HR of 1.17 (95% CI 1.01-1.36). Significant determinants of depression included number of tophi, frequency of flares, and oligo/polyarticular gout.

CONCLUSION

Our systematic review suggests that depression and anxiety are significantly associated with gout, highlighting the need for future research to focus on the onset of mental disorders after gout diagnosis. We also identify potential targets for intervention.

Pain and affective distress in arthritis: relationship to immunity and inflammation

INTRODUCTION

Most arthritides are associated with pain and psychological distress (clinically significant depression and anxiety). Pain and depression are mutually exacerbating; both may continue even when joint involvement appears well controlled. Area covered: There is strong evidence that arthritis-related stress impacts the central nervous system and, together with peripheral inflammatory changes, can cause central sensitization that can lead to chronic pain and worsening of affective distress. Cytokines and chemokines participate both in joint inflammation and in central sensitization. We review evidence of these relationships in five arthritides, namely rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, gout, and in osteoarthritis of the hips and knees. Central sensitization in these conditions results in long-lasting pain and psychological distress. Expert commentary: Chronic pain and depression are important but often neglected in the clinical assessment and treatment of arthritis. The potential role of biologic cytokines and Janus kinase inhibitors in dealing with these symptoms needs further study.

Lower vitamin D levels are associated with depression in patients with gout

BACKGROUND

Depression is commonly observed among patients with gout. Low levels of vitamin D have been associated with depression in non-gout subjects. We examined the association of vitamin D levels with depression in patients with gout.

METHODS

We conducted a cross-sectional study of 186 gout patients at the Endocrinology Department of First Affiliated Hospital of Jiaxing University. Levels of serum 25-hydroxyvi-tamin D (25(OH)D) were determined using a competitive protein-binding assay. The 17-item Hamilton Depression Scale was used for screening for depressive symptoms. Diagnosis of depression in gout patients was made in accordance with Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria for depression. Multivariate analysis was performed using logistic regression models.

RESULTS

Thirty-two gout patients (17.2%) were diagnosed as having depression. Patients with depression showed significantly lower 25(OH)D levels as compared to patients without depression (46.4±19.0 vs 57.0±17.3 nmol/L, P<0.001). Significant differences in 25(OH)D quartiles of gout patients were observed between the patients with depression and the patients without depression (P=0.003). In multivariate analyses, serum 25(OH)D levels (≤40.0 nmol/L) were independently associated with depression in patients with gout (OR 3.833, 95% CI 1.406-10.453, P=0.009).

CONCLUSION

Our study demonstrates an important association between serum vitamin D levels and depression in patients with gout.

Depression and Its Association with Health-Related Quality of Life in Postmenopausal Women in Korea

Menopause is associated with depressive symptoms that can significantly affect a woman's quality of life. The objective of this study was to evaluate the association between depression and health-related quality of life (HRQoL) in postmenopausal women. In this cross-sectional descriptive study, participants (n = 3860) were selected from the 2013⁻2015 Korea National Health and Nutrition Examination Survey (KNHANES). The sociodemographic characteristics, medical history of depression, and EQ-5D scores of the participants were obtained from the KNHANES dataset. Age, educational level, and income were associated with HRQoL in these participants. Moreover, depression exerted a considerable influence on HRQoL in postmenopausal women. The adjusted odds ratios in participants with depression for the EQ-5D dimensions were as follows: 5.52 (95% CI = 4.04⁻7.55, p < 0.001) for anxiety/depression, 3.86 (95% CI = 2.78⁻5.36, p < 0.001) for usual activities, and 2.52 (95% CI = 1.68⁻3.78, p < 0.001) for self-care. Our findings suggest a strong association between depression and HRQoL. Hence, preventing the onset or exacerbation of depression may significantly improve quality of life in postmenopausal women.

A Chinese cross-sectional study on depression and anxiety symptoms in patients with psoriasis vulgaris

Previous studies have reported a higher incidence of depression and anxiety in psoriasis patients compared to the general population, which has important implications for assessment and treatment. In this study, we determined the frequency of depression and anxiety in Chinese patients with psoriasis and its relationship with disease severity and other demographic variables. The study included 208 Chinese patients with psoriasis vulgaris. The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7) were used to screen for depression and anxiety. The Psoriasis Area and Severity Index (PASI) was used to assess the severity of psoriasis. Of the 208 patients included in the study, 29 patients (13.9%) were positive for moderate-to-severe depression (PHQ-9 ≥ 10) and 22 patients (10.6%) were positive for anxiety (GAD-7 ≥ 10) symptoms. Both positive stress reactors who perceived stress as an exacerbating factor of psoriasis and moderate-to-severe psoriasis were found to be positive predictors for the presence of moderate-to-severe depression or anxiety symptoms while longer duration and late onset age played a protective role. In the sample of Chinese patients with psoriasis there was a clinically significant prevalence of depression and anxiety. Our study suggests that Chinese psoriasis patients should be screened for psychiatric comorbidities.