People with rheumatoid arthritis, or RA, are more than three times as likely to die within a year of showing symptoms of depression as people with RA who do not have such symptoms. The findings were presented today at the 2012 annual meeting of the American College of Rheumatology, held in Washington, D.C.  

“These findings suggest that patients with RA should be alert to their feelings of sadness and depression and be willing to discuss them with their health care practitioner,” says study co-author Patricia Katz, PhD, professor of medicine and health policy at the University of California, San Francisco.

This is especially true for men, Katz notes. In the study, men with RA who reported having feelings of worthlessness and emptiness or, for example, disengaging from activities that were once enjoyed, were five times more likely to die within the next year than women with RA and no depressive symptoms.

“Men are less likely to be proactive about seeking help, so it is important for men with RA to be aware of their feelings and be willing to discuss them with their doctor,” Katz says.

Katz and colleagues reported on a group of 530 RA patients from clinics in Northern California, who were followed from 2002 or 2003 until 2009 or death. The mean age was 60, and 84 percent were women.

All patients participated in annual telephone interviews in which they responded to 15 questions from the Geriatric Depression Scale (GDS), which measures feelings of anxiety, fulfillment and/or hopelessness. If they answered yes to at least five of the questions, they were considered to have significant levels of depressive symptoms. Katz emphasized that this was not a formal diagnosis of depression, just a red flag that the patient had symptoms associated with depression.

Patients with a score of 5 or higher on the GDS were 3.5 times more likely to die in the following year than those with lower scores. Also, patients with a GDS score that worsened by 2 points or more from one year to the next were at least two times more likely to die within the following year than those whose score did not go up as much.

Katz explains that a trigger for depression can be the loss of ability to participate in activities that are important to patients. “A take-home message is that if you are having trouble performing activities that are important to you, perhaps you can find another way to do them,” she says. “Physical or occupational therapy or a change in medication may help. If these strategies don’t work, try to find other activities that are rewarding to you to replace the ones you have lost.”

The study presented at ACR builds on a wealth of evidence that depression is a significant factor for poor health outcomes, especially in people with RA. 

One study, presented in 2009 at the annual European League Against Rheumatism meeting, showed that 63 percent of RA patients in the study had a psychiatric disorder, most commonly depression.

Another study, published in BMJ earlier this year, found that levels of psychological distress (defined as depression and anxiety) were correlated with increased mortality, and that even low levels of psychological distress increased the risk of dying. 

Amanda Nelson, MD, assistant professor of medicine at the University of North Carolina Thurston Arthritis Research Center, Chapel Hill, said that although the link between depression and mortality is not new, this study reinforces the association between the two factors.

“Other studies have shown that depression in the general population, in people with cardiovascular disease, and in older people is associated with higher rates of mortality,” says Dr. Nelson, who was not involved in the study presented today.

“If a patient notices that he or she is having any of the common symptoms of depression, the patient should discuss it with the health care practitioner rather than waiting for the practitioner to ask about it,” says Dr. Nelson. “Depression is treatable if it is recognized.”