The Relationship Between Mental Health, Disease Severity, and Genetic Risk for Depression in Early Rheumatoid Arthritis

TY - JOUR

T1 - The Relationship Between Mental Health, Disease Severity, and Genetic Risk for Depression in Early Rheumatoid Arthritis

AU - Euesden, Jack

AU - Matcham, Faith

AU - Hotopf, Matthew

AU - Steer, Sophia

AU - Cope, Andrew P.

AU - Lewis, Cathryn M.

AU - Scott, Ian C.

PY - 2017/7

Y1 - 2017/7

N2 - Introduction Reduced mental health is prevalent in rheumatoid arthritis (RA). Although longitudinal studies are limited, there is evidence that depression associates with worse disease outcomes. We evaluated reciprocal relationships between mental health, RA severity and genetic risks for depression over 2-years in a well-characterised cohort of RA patients. MethodsWe evaluated 520 early RA patients previously enrolled to two clinical trials. Mental health was measured using the SF-36 mental health (MH) domain and mental component summary scores (MCS). MCS/MH associations over two-years with disease activity (DAS28), disability (HAQ), pain visual analogue scale (VAS) scores, and a weighted genetic risk score (wGRS) for depression, were tested using linear mixed-effects and regression models.ResultsPoorer mental health associated with worse RA outcomes. Lower MCS scores (indicating worse mental health) were seen in patients with a greater genetic risk for depression (wGRS β=-1.21; P=0.013). Lower baseline MCS associated with lower 2-year improvements in DAS28 (β=-0.02; P<0.001), pain (β=-0.33; P<0.001), and HAQ (β=-0.01; P=0.006). Baseline MCS associated with changes in the swollen joint count (β=-0.09; P<0.001) and patient global assessment (β=-0.28; P<0.001), but not the tender joint count (P=0.983) and erythrocyte sedimentation rate (P=0.973). Only baseline pain VAS (β=-0.07; P=0.002) associated with 2-year changes in MCS.ConclusionsReduced baseline mental health associated with lower improvements in disease activity, disability, and pain over two years, supporting current national guidelines recommending screening for depression in RA. Pain had a bidirectional relationship with mental health. Depression genetic risk had a significant association with mental health.

AB - Introduction Reduced mental health is prevalent in rheumatoid arthritis (RA). Although longitudinal studies are limited, there is evidence that depression associates with worse disease outcomes. We evaluated reciprocal relationships between mental health, RA severity and genetic risks for depression over 2-years in a well-characterised cohort of RA patients. MethodsWe evaluated 520 early RA patients previously enrolled to two clinical trials. Mental health was measured using the SF-36 mental health (MH) domain and mental component summary scores (MCS). MCS/MH associations over two-years with disease activity (DAS28), disability (HAQ), pain visual analogue scale (VAS) scores, and a weighted genetic risk score (wGRS) for depression, were tested using linear mixed-effects and regression models.ResultsPoorer mental health associated with worse RA outcomes. Lower MCS scores (indicating worse mental health) were seen in patients with a greater genetic risk for depression (wGRS β=-1.21; P=0.013). Lower baseline MCS associated with lower 2-year improvements in DAS28 (β=-0.02; P<0.001), pain (β=-0.33; P<0.001), and HAQ (β=-0.01; P=0.006). Baseline MCS associated with changes in the swollen joint count (β=-0.09; P<0.001) and patient global assessment (β=-0.28; P<0.001), but not the tender joint count (P=0.983) and erythrocyte sedimentation rate (P=0.973). Only baseline pain VAS (β=-0.07; P=0.002) associated with 2-year changes in MCS.ConclusionsReduced baseline mental health associated with lower improvements in disease activity, disability, and pain over two years, supporting current national guidelines recommending screening for depression in RA. Pain had a bidirectional relationship with mental health. Depression genetic risk had a significant association with mental health.

U2 - 10.1097/PSY.0000000000000462

DO - 10.1097/PSY.0000000000000462

M3 - Article

SN - 0033-3174

VL - 79

SP - 638

EP - 645

JO - Psychosomatic Medicine

JF - Psychosomatic Medicine

IS - 6

ER -