Depressive Symptoms Linked to Greater Risk of Gout

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Patients with depression had a greater risk of gout compared with patients without depression, a new study found.¹

“Patients with depression have a higher risk of gout but a lower willingness to accept treatment compared with patients without depression,” investigators, led by Siyi Lu, from the department of rheumatology at Dongfang Hospital Beijing University of Chinese Medicine, wrote. “This difference between morbidity and management outcomes for gout emphasizes that current post-diagnostic care for patients with depression and gout is insufficient to achieve adequate treatment for both gout and depression.”

People with gout have a lower quality of life due to their chronic pain and their financial burden—which ultimately can affect their mental health. In 2022, Joseph Coe, MPA, told HCPLive about his study where his team used artificial intelligence (AI) to garner insight into mental health outcomes in patients with gout.²

“We hypothesize that there are a few reasons why depression and anxiety with gout overlap,” Coe said. “One possibility is that pain from gout can lead to emotional distress. Additionally, we've seen through this research, and through our work with CreakyJoints, that if gout [is] left untreated it can cause tremendous flares [that] can increase the likelihood of depression and anxiety.”

A 2021 meta-analysis found up to 40% of gout patients suffer from depression.¹ Lu and colleagues wanted to assess the association between gout prevalence and treatment rate with the severity of depression in the US so they conducted a cross-sectional analysis of the 2007 – 2018 National Health and Nutrition Examination Survey (NHANES) for participants with depression. The study included 25,022 patients who were non-pregnant adults > 20.

The team used Patient Health Questionnaire-9 (PHQ-9) scores and categorized depression symptom severity as none (0 – 4), mild (5 – 9), moderate (10 – 14), moderately severe (15 – 19), and severe (20 – 27). Gout was either defined as self-reporting a gout diagnosis by a health professional or using anti-gout medications including Allopurinol, Febuxostat, and Probenecid. For the analysis, the team used multivariable logistic regression to control for confounders.

Investigators adjusted for covariates, such as age (broken into age groups: 20 – 39, 40 – 59, 60 – 79, ≥ 80), sex, race (non-Hispanic White, non-Hispanic Black, Mexican American, and other), BMI, smoking, alcohol consumption, recreational activity, marriage status, education, household income, and health insurance. Additionally, they considered comorbidity factors such as hypertension, congestive heart failure, heart attack, stroke, and angina.

In total, 25% of the participants reported depressive symptoms were mild or more severe. Investigators found when the severity of depressive symptoms worsened from mild (adjusted odds ratio [aOR], 1.171; 95% CI, 1.40 – 2.08), moderate (aOR, 1.31; 95% CI, 0.82 – 2.11), and moderately severe (aOR, 1.21; 95% CI, 0.62 – 2.38), the risk of gout increased (P = .01) and had a downward trend in the demographic factors of sex, ethics, and age.

A similar trend was observed in behavioral and socioeconomic factors and co-morbidity (P < .0001). However, after adjusting for all factors, the lower gout prevalence had no statistical significance (P = .98).

Many patients (80.1%) with depression received treatment but not many did with severe depression (0.2%). Investigators observed participants who had more severe depression had a lower treatment rate (P = .05). Thus, participants with depression and gout had a downward trend of not receiving treatment (P < .001).

“With the aggravation of depression, the prevalence of gout and the rate of treatment both were decreased,” investigators wrote.

Investigators pointed out multiple limitations including the lack of clarity of how the association between gout and depression is casually related in a cross-sectional study, not including a dietary gout pattern, and the small sample size led the association in the subgroup analysis to be inaccurate.

“In conclusion, this study emphasizes the close relationship between the severity of depressive degrees and the prevalence and treatment rate of gout in patients with gout and depression co-morbidity, as well as the urgent need to improve post-diagnostic depression and gout patients' care,” investigators wrote. “Moreover, present nursing care for managing gout or depression is still fragmented advice, and long-term cooperative care after diagnosis for gout and depression should be carried out given their chronic burden.”

^References

1. ^{Lu S, Qian T, Cao F, et al. Prevalence and treatment rate of gout by depressive symptom severity: A cross-sectional analysis of NHANES 2007-2018. Int J Rheum Dis. 2024;27(1):e14959. doi:10.1111/1756-185X.14959}
2. ^{Pine, L. Joseph Coe, MPA: Using Social Media to Better Understand Mental Health in Patients with Gout. HCPLive. November 12, 2022. https://www.hcplive.com/view/joseph-coe-mpa-using-social-media-to-better-understand-mental-health-in-patients-with-gout. Accessed February 21, 2024.}