Rheumatoid Arthritis with Depression Puts Patients at Greater Risk of Mortality

Srikanta Banerjee, PhD

Credit: ResearchGate

Although a new study found there was no significant difference in mortality between patients with and without rheumatoid arthritis (RA), the risk of mortality was statistically greater in patients with both RA and depression. Thus, depression increases the risk of mortality among individuals with RA.¹

In 2020, more than 3 million people globally had disability-adjusted life years linked with RA—and > 35,000 individuals died from this autoimmune condition. The prevalence of RA keeps growing; 15 – 20 million people had RA in 2020, which had increased by 14.1% from the year 1990. The prevalence is projected to exceed 30 million by 2050.

Comorbidities of RA are associated with poorer health outcomes, reduced quality of life, and greater disability. Although common comorbidities are cardiovascular diseases, respiratory illnesses, malignancies, and psychiatric conditions, depression is the most researched comorbidity for RA, with studies evaluating the prevalence of major depressive disorder among RA patients, ranging from 6 – 66%, according to one study, and 16.8% in another study.

A 2023 study found half of the rheumatoid arthritis patients in their sample had high rates of depression and anxiety, highlighting the importance of psychiatric assessments and mental status evaluations for patients with RA.²

“Depression is extremely common in patients with RA, with an incidence 1.7-fold greater than in individuals without RA,” wrote investigators of the 2023 study.

Once again, investigators examined the relationship of RA and depression.¹ Led by Srikanta Banerjee, PhD, from the College of Health Sciences at Walden University in Minneapolis, the team conducted a prospective study to assess the mortality risk in community-dwelling American adults with RA, depression, or both.

The study used a complex, multi-stage, probabilistic sample design. Investigators linked individual participant data from the mortality data from the National Death Index up to December 31, 2019, to the National Health and Nutrition Examination Survey (NHANES) data from 2005 – 2010 on US adults aged > 30 years. On average, participants had a follow-up duration to mortality of 9.6 years.

Other than mortality, the team assessed sociodemographic and health-related variables in the multivariable analysis. For instance, they assessed age, sex race, income, education, body mass index (BMI), as well as if they smoked, had a history of hypertension, cancer, or cardiovascular diseases (CVD).

In total, 22,155 US adults were in the sample, and 1670 had RA. Participants were more likely to have RA if they were female, older, Black, widowed or divorced, or had a lower education or income level. They were also more likely to smoke, have a greater BMI, report anemia, have moderate or severe depression, or have a history of hypertension, cancer, or CVD.

An adjusted analysis found no significant mortality difference between participants with and without RA (hazard ratio [HR], 1.24; 95% CI, 0.60 – 2.59). However, the mortality risk was statistically greater in participants with both RA and depression (HR, 2.44; 95% CI, 1.14 – 5.21). Smoking, age, and income served as consistent moderators for the relationship between RA or depression and mortality.

“While RA or depression alone did not significantly predict the risk of mortality, having both RA and depression increased the risk of mortality by more than two times,” investigators wrote.

^References

1. ^{Banerjee, S, Khubchandani, J, Noonan, L. Risk of Mortality Among People with Rheumatoid Arthritis and Depression. The Egyptian Rheumatologist. 2024; 46. https://doi.org/10.1016/j.ejr.2023.12.004}
2. ^{Pine, L. Half of Patients with Rheumatoid Arthritis Reported Symptoms of Depression. HCPLive. April 3, 2023. https://www.hcplive.com/view/half-of-patients-with-rheumatoid-arthritis-reported-symptoms-of-depression. Accessed February 13, 2024.}