Rheumatoid arthritis patients with lower socioeconomic statuses are more depressed and have more severe depression symptoms than people with higher socioeconomic statuses, according to a study in the February 2011 issue of Arthritis Care & Research.

“If two patients have the same amount of functional limitation [for instance, difficulty tying their shoes or combing their hair] but one patient is less educated and has less income, that patient will have more depression than another patient that has higher socioeconomic factors,” explains lead study author Mary Margaretten, MD, an assistant professor of medicine in the division of rheumatology at the University of California, San Francisco.

Researchers analyzed data from more than 800 medical appointments involving 466 patients. About half went to an urban county public hospital, while the other half went to a university medical center. The same doctors treated patients at both sites and all patients filled out questionnaires that assessed their levels of depression.

Compared with patients who went to the university medical center, patients at the public hospital had less education, lower household incomes, less access to health care and were more likely to be female, immigrants and not Caucasian. They had higher levels of disease activity, needed more treatment and had higher depression scores.

“It’s not just that socioeconomic status and disability leads to depression. It’s the combination of the two,” Dr. Margaretten says.

Researchers can’t say why for sure, but they suspect it’s because those with lower socioeconomic status don’t have the same kinds of support or access to care as those with higher socioeconomic status.

In any case, they say if you or a loved one shows signs of depression, mention it to your health care provider – because your provider may or may not be looking for signs of depression, which should be treated. Depression can lead to poor medication adherence and increased health risks.

“We get so busy in the clinic with looking at medication lists and X-rays and checking blood and looking at swelling, that mental health isn’t always well addressed,” Dr. Margaretten says.

Leigh Callahan, PhD, is an associate professor of medicine at the University of North Carolina’s Thurston Arthritis Research Center in Chapel Hill. She says it would have been nice if the study identified socioeconomic status by individual factors like education level or income rather than the hospital site visited, but she says it’s still significant research.

“It’s another study that reinforces the importance of recognizing the impact socioeconomic status has on both health outcomes and depression,” Callahan says.

She says, for example, patients with poor functional status who work in a manual labor job may be less able to keep working if their RA worsens terribly and their job doesn’t allow them to control the pace of work in the same way a white-collar job might allow. This could cause someone to grow increasingly depressed.

“For the doctors it highlights, if they see someone with low levels of socioeconomic status, they need to be thinking about the range of things that go on,” Callahan says. “It’s a matter of clueing in that there may be an even greater need for individuals with lower socioeconomic status to have supportive interventions.”