Arthritis and Depression: It's Not All In Your Head

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Arthritis patients with high perceived disability reported more severe depressive symptoms

September 20, 2013 / Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

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(dailyRx News) Arthritis, which can lead to painful bones and joint damage, is a physical condition. However, according to recent research, it may also affect patients' mental health.

A recent study looked at arthritis patients to see if there was a link between their physical abilities, perceived level of disability and mood.

The researchers found that patients who perceived their disability to be more limiting were more likely to be depressed than patients who thought their arthritis did not limit them very much. Also, arthritis patients who did not do as well on certain exercises measuring their ability had lower moods.

According to the researchers, the conclusions of this study could be used to change how doctors treat arthritis by addressing coping skills along with physical symptoms.

"Seek help for coping with your disabilities."

Katie Becofsky, of the Department of Exercise Science in the University of South Carolina, led this study to see if a link existed between physical disability with arthritis and depressive symptoms.

Arthritis refers to over 100 conditions in which joints become painful and stiff due to inflammation. About 50 million adults in the US have been diagnosed with arthritis, and that number continues to grow.

A previous study showed that a significant number of people with arthritis also had depression, a mental health condition characterized by a persistent low mood.

It is possible that the limited physical ability that comes with arthritis could make an arthritis patient more likely to have depression. This study aimed to observe arthritis patients' self-reported depressive symptoms.

The researchers used data from STEPS to Health, a trial on healthy living and arthritis that separated participants into an exercise program or a nutrition program. Participants in the study had been previously diagnosed with some form of arthritis or a similar disease, such as lupus, or they had reported a symptom of arthritis.

Altogether, 401 adults with arthritis, most of whom were women, participated in the study. The participants were asked to rate their depressive symptoms on a scale from zero to three based on a 10-item questionnaire called the Center for Epidemiological Studies Depression Scale.

Then the arthritis patients participated in a series of exercises so that the researchers could measure their strength and flexibility. Different tests were used to record upper and lower body strength, flexibility, walking speed and balance.

Lastly, participants were asked to measure their perceived disability in a 20-item questionnaire. On a scale of zero to three, the participants measured how difficult various activities were for them over the past week.

The researchers found that patients who did not perform as well as others on the chair stand test, which measured lower body strength, were more likely to exhibit depressive symptoms. The chair stand test measured how many times in a 30-second period a person could sit down in a chair and stand back up using only their legs.

"This measure may be a particularly strong indicator of mental health status, perhaps because lower body strength is most essential to completing activities of daily living and maintaining independence," the researchers wrote.

But the strongest association was between perceived disability and depressive symptoms. Participants who felt as though they could not accomplish their daily activities without help were more likely to be depressed, even if they had an average score on the physical tests.

The researchers emphasized that depression and arthritis are a cycle — when a person's mental state worsens, their physical health will also decline, which could lead to more depressive symptoms.

For people with arthritis, physical therapy and pain relief may result in incomplete treatment if the patient's mental health is not addressed, according to the study.

The researchers concluded, "To reduce the risk of depression in adults with arthritis, it may be critical not only to alleviate the physical symptoms contributing to functional limitation but also to teach coping skills that can help physically limited individuals maintain their daily routine as much as possible."

The authors noted that the study was limited because only 14.2 percent of participants were men. Additionally, because the study did not have a control group, the causal relationship between disability and depression could not be firmly established.

"Results indicate that it is not merely actual physical aptitude levels that contribute to depressive symptoms but perceived physical aptitude as well. Participants who, regardless of their actual ability level, believed that they had a high level of disability had higher depression," Dr. Jamie Kuhlman, a licensed psychologist in private practice in Austin, Texas, told dailyRx News.

"In order to lessen depressive symptoms, it is important to not only increase the physical ability of people with arthritis but to also increase their feelings of self-competence and daily independence," said Dr. Kuhlman.

The article was recently published in the journal Arthritis.

The research was funded by the Centers for Disease Control and Prevention's National Center for Chronic Disease Prevention and Health Promotion. The researchers did not disclose conflicts of interest.