Are we missing the diagnosis of depression in patients with rheumatoid arthritis at a tertiary care facility?

Objectives: To determine if we are missing clinical depression in patients with Rheumatoid Arthritis and its relationship with functional disability and level of formal education in such patients.

Methods: The data for this cross-sectional, analytical study was gathered from May 2015 till December 2015 and comprised of 128 with Rheumatoid arthritis diagnosed according to ACR/EULAR 2010 criteria. The study was conducted at Fauji Foundation Hospital Rawalpindi. Functional status was assessed with Modified Health Assessment Questionnaire (mHAQ) and Beck’s Depression Inventory (BDI) was used for evaluation of symptoms of depression. The relation between depression, functional disability and educational status was established using Pearson correlation coefficient.

Results: The study included 128 patients with no previous diagnosis of depression. 122 (95.3%) were females and 6 (4.7%) were males. The mean age was 51.75 ± 9.25 years. Mean duration of disease was 8.95 ± 7.1 years. According to this study, the diagnosis of clinical depression was missed in 47.7% of patients with Rheumatoid Arthritis who had been under regular follow up at a tertiary care facility. About 18% were keen to seek professional help for depressive symptoms while 62.6% had functional disability (mild – severe). There is a positive correlation with BDI (Pearson’s correlation +1) and functional disability. No correlation could be established between level of education and depression as out of 79 (61.7%) patients with no basic education, 45.5% had depression. In remaining 49 (38.2%) patients, with some formal education, 51.3% had clinical depression.

Conclusion: Almost half of the patients with Rheumatoid Arthritis coming to a tertiary care set up had clinical depression but were never diagnosed or referred to a Psychiatrist. There is a positive correlation between depression and functional disability; however no statistically significant correlation could be established with the level of formal education. The study further emphasizes the importance of early recognition and swift referral of such patients to a psychiatrist since it is known to improve both treatment outcomes and functional status.