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 Table of Contents    
ORIGINAL ARTICLE  
Year : 2019  |  Volume : 61  |  Issue : 5  |  Page : 444-450
Depressive symptoms and the risk of arthritis: A survival analysis using data from the osteoarthritis initiative


1 Department of Pharmacy, School of Pharmacy, Lingaya's University, Faridabad, Haryana, India; Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
2 Department of Pharmacology, Mulayam Singh Yadav Medical College and Hospital, Meerut, Uttar Pradesh, India
3 Department of OBS and Gynaecology, Mulayam Singh Yadav Medical College and Hospital, Meerut, Uttar Pradesh, India

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Date of Web Publication3-Sep-2019
 

   Abstract 


Background: Some studies investigated the association between depressive symptoms and arthritis; however, no longitudinal studies have documented the relationship between developing depressive symptoms and the risk of arthritis. Therefore, this study evaluated whether the development of depressive symptoms was associated with an elevated risk of arthritis.
Materials and Methods: A survival analysis using Cox regression models was applied to osteoarthritis initiative data obtained over 6 years from adults (n = 3,662) aged ≥45 years at baseline. Developing depressive symptoms was defined using the 20-item Center for Epidemiologic Studies Depression scale (cutoff 16 points) between baseline and 1 year. Arthritis was defined answering “yes” to the following self-reported question: “Did the doctor say you developed arthritis since the last clinic visit about 1 year ago?” over the 6-year follow-up period.
Results: The hazard ratios for developing arthritis were 3.51 (95% confidence interval [CI] = 2.32–5.29) and 2.03 (95% CI = 1.45–2.85) for men and women, respectively, as compared to those who did not develop depressive symptoms. There was a significantly (χ2 = 73.672, P < 0.0001) lower survival probability at each time point throughout the study among men and women who developed depressive symptoms.
Conclusion: In both men and women, developing depressive symptoms increased the risk of arthritis, and the survival probability decreased at each time point.

Keywords: Arthritis, Cox regression models, depressive symptoms MeSH terms: Arthritis, depression

How to cite this article:
Vennu V, Misra H, Misra A. Depressive symptoms and the risk of arthritis: A survival analysis using data from the osteoarthritis initiative. Indian J Psychiatry 2019;61:444-50

How to cite this URL:
Vennu V, Misra H, Misra A. Depressive symptoms and the risk of arthritis: A survival analysis using data from the osteoarthritis initiative. Indian J Psychiatry [serial online] 2019 [cited 2019 Sep 19];61:444-50. Available from: http://www.indianjpsychiatry.org/text.asp?2019/61/5/444/265873





   Introduction Top


Depression is a leading global cause of disability,[1],[2] affecting 350 million people worldwide.[2] Depression might develop because of environmental (e.g., medical illness, obesity, stress, and poor sleep) or genetic factors that alter the immune and inflammatory process.[3] Many studies have provided evidence of the association between several genes related to immunoinflammation and depression.[4],[5] These symptoms are strongly associated with cardiovascular disease, diabetes, chronic obstructive pulmonary disease, and chronic musculoskeletal disorders like arthritis;[6],[7] however, the associations remain heterogeneous.[8] Moreover, most studies examining depression and arthritis comprised small sample sizes.[9]

Arthritis is a general medical condition; it comprises over 100 distinct diseases and conditions.[10] Arthritis is a major and growing public health problem with a sizeable impact on individuals' functional capacity and the ability to perform activities of daily living.[11],[12],[13],[14] It is also associated with severe pain,[15] psychological distress,[16] and depression.[17],[18] There are approximately 750,000 hospitalizations[19] and 36 million outpatient visits annually attributed to arthritis.[20] It has been estimated that about 67 million adults will have self-reported doctor-diagnosed arthritis by the year 2030.[10]

There is an ample body of research on arthritis and its associated factors.[18],[21],[22],[23],[24],[25] Some of these studies demonstrated a relationship between depressive symptoms and arthritis.[18],[24],[25] However, this relationship remains unclear. For example, Rathbun et al.[25] examined the transient impact of depressive symptoms on the longitudinal change of rheumatoid arthritis (RA) disease activity. The results demonstrated that depressive symptoms temporally influence the evolution of RA disease activity, and the magnitude was dependent on the time of symptoms' onset. Further, a cross-sectional general population study estimated the association between depressive symptoms and physical diseases in Switzerland.[7] The results showed that those with depressive symptoms had a higher chance of developing a physical illness like arthritis than did those who did not. Moreover, a recent study reported that higher scores for depressive mood and lower scores for social support were longitudinally not associated with the development of arthritis in patients with seropositive arthralgia, although they predict increased musculoskeletal symptoms, such as pain, aches, and stiffness.[26] Another longitudinal study suggested that chronic arthritis-related pain and depressive symptoms frequently co-occur in late life.[27] Notably, these studies differ from that of the present study in methodology, study population, terms, and definitions of depressive symptoms and arthritis. Thus, the goal of this study was to assess this relationship. It was hypothesized that developing depressive symptoms would increase the risk of developing arthritis.


   Materials and Methods Top


The current study used data from the osteoarthritis initiative (OAI), a publicly and privately funded multicenter, longitudinal, observational study examining the onset and progression of knee osteoarthritis. The OAI study enrolled men and women between February 2004 and May 2006 from four clinical sites in the United States (Baltimore, MD; Pittsburgh, PA; Pawtucket, RI; and Columbus, OH). An overview of this study is described elsewhere.[28] This study received ethical approval from the Committee on Human Research of the Institutional Review Board at the University of California, San Francisco and its affiliates (approval number: FWA00000068). All participants provided written, informed consent before participating.

In this longitudinal study, the approach taken to analyze the datasets is illustrated in [Figure 1]. Specific datasets were used: 0.2.2, 1.2.1, 3.2.1, 5.2.1, 6.2.1, and 8.2.1. Participants (n = 3,662) who were aged ≥45 years at baseline and did not already have depressive symptoms were followed over 6 years. The participants were divided into two groups: those (n = 153) who had depressive symptoms but did not have arthritis between baseline and 1-year follow-up and those (n = 3509) who had neither depressive symptoms nor arthritis. Participants who were diagnosed with arthritis between the 1- and 6-year follow-up periods were compared to determine whether having depressive symptoms was associated with an elevated risk of developing arthritis.
Figure 1: Analysis of the risk of arthritis over time in participants aged ≥45 years who did not already have depressive symptoms

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Depressive symptoms' status at baseline and during the 1-year follow-up period was assessed using the self-reported, 20-item Center for Epidemiologic Studies Depression Scale (CES-D). This scale captures the frequency of feelings and behaviors over the past 7 days and is measured on a four-point scale (0 = rarely or none of the time to 3 = most or all the time). The scale items were summed; total scores ranged from 0 to 60, with higher scores indicating greater depressive symptoms.[29] A cutoff score of 16 was used: depressive symptoms if the score ≥16 and no depressive symptoms if the score was <16.[30],[31] The scale demonstrated excellent validity in the current sample.[32]

Arthritis was defined answering “yes” to the following self-reported question over the 6-year follow-up period: “Did the doctor say you developed arthritis since the last clinic visit about 1 year ago?” Similar questions were used in another national survey[33] and epidemiological studies[34] with adequate sensitivity and specificity.[35]

According to the available literature, the following potential covariates were included in the analyses: age (years), sex (female/male), race (non-Caucasian/Caucasian), education (≤ primary school/≥ high school), marital status (married/unmarried), annual income ([36] and body mass index (BMI; kg/m2) was used to determine obesity.[37]

A flowchart of the current study sample is shown in [Figure 2]. There were 4,796 participants in the OAI study. Participants who already had depressive symptoms (n = 480) or arthritis (n = 654) at baseline were excluded from analyses; therefore, the final sample size was 3,662. Excluded participants (n = 1,134) were significantly more likely than included participants to be younger (59.0 years), unmarried (34%), live alone (22%), and obese (BMI = 30 kg/m2) than were those who were included in this study.
Figure 2: Flowchart of the study sample

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As a part of the survival analysis, interval censoring was considered by undertaking periodic assessment (such as the annual interview of respondents in the OAI study), and the event of interest (in this case, arthritis) is known to occur in the interval between two assessments. Therefore, those who participated in every year (up to 6 years) were included in analyses. A Kaplan–Meier estimate of survival function (survival being determined as not developing arthritis) was initiated to investigate how the unadjusted survivor function for the two groups (those who had depressive symptoms between baseline and 1-year follow-up and those who did not have depressive symptoms) changed over time. Whether possible confounding variables such as age, sex, race, marital status, education, annual income, healthcare coverage, comorbidity, and BMI in the 1-year follow-up period were predictive for the risk of developing arthritis was examined by univariate analysis using Chi-square tests.

The risk of arthritis for the two groups was computed using a Cox regression model to show the hazard function. The model was adjusted for age, sex, race, marital status, education, annual income, healthcare coverage, comorbidity, and BMI in the 1-year follow-up period. The analysis was performed separately in men and women to determine the sex differences in having depressive symptoms and the risk of arthritis. All data processing and analyses were performed with Statistical Analysis Software version 9.3 (SAS Institute Inc., NC, USA) for Windows.


   Results Top


Between baseline and the 1-year follow-up, 153 participants developed depressive symptoms. Participants' characteristics stratified by the group are shown in [Table 1]. Between baseline and the 1-year follow-up, those who developed depressive symptoms were significantly unmarried, lived alone, obese, and had less annual income than did those who had neither depressive symptoms nor arthritis [Table 1].
Table 1: Participants' characteristics stratified by group

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Results of the univariate analysis are shown in [Table 2]. Between the 1- and 6-year follow-up, there was no significant difference in the likelihood of men and women to develop arthritis. Compared to those who were married or lived with others, a higher percentage of the unmarried/divorced/widowed participants and those who lived alone had a significantly higher risk of developing arthritis. Participants with less annual income and healthcare coverage and those who were obese were significantly more likely to develop arthritis compared to their counterparts.
Table 2: Results of the univariate analysis

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The Kaplan–Meier survival curve for the risk of arthritis between 1- and 6-years follow-up for both groups is shown in [Figure 3]. There was a significantly (χ2 = 73.672, P < 0.0001) lower survival probability at each time point throughout the study period among men and women who developed depressive symptoms only between baseline and 1 year, as compared to those who had neither depressive symptoms nor arthritis.
Figure 3: Probability of arthritis over time in initially arthritis-free men and women who were having depressive symptoms at 1 year follow-up and in those who were not having depressive symptoms. Dep = 0 sex 1 = 1, men who did not have depressive symptoms; dep = 0 sex 1 = 2, a woman who did not have depressive symptoms; dep = 1 sex 1 = 1, men who had depressive symptoms; dep = 1 sex 1 = 2, a woman who had depressive symptoms

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Cox regression models in [Table 3] show the effect of developing depressive symptoms and the risk of developing arthritis between 1- and 6-years in men and women. Compared to both men and women who had neither depressive symptoms nor arthritis, men and women who had developed depressive symptoms between baseline and 1 year were significantly more likely to have arthritis. [Table 3] also shows that being younger and African American/Asian/other decreased the hazard ratio for the risk of arthritis for women. In both sexes, obesity increased the hazard ratio of the risk of arthritis, whereas having no healthcare coverage increased the hazard ratio of the risk of arthritis in men only.
Table 3: Cox regression model estimating the hazard function of developing arthritis over time, stratified by sex

Click here to view



   Discussion Top


To the best of our knowledge, this was the first study to evaluate whether developing depressive symptoms is associated with an increased risk of developing arthritis. The findings support the hypothesis that developing depressive symptoms elevated the risk of arthritis in both men and women as compared to those who did not have depressive symptoms. Both men and women who developed depressive symptoms between baseline and the 1-year follow-up had a lower probability of not having arthritis at each time point throughout the study period. Furthermore, obesity and having no healthcare coverage increased the risk of arthritis in both sexes if they had developed depressive symptoms between baseline and 1 year.

Previous findings showed that low education, disease activity, and disability were associated with developing depressive symptoms, and they were also associated with having arthritis.[38],[39] Moreover, previous studies reported that individuals who had depression and arthritis displayed more significant functional impairment and worse health-related quality of life (HRQoL) compared to those who did not have depression but had arthritis.[21],[40] Research also demonstrated a temporal association between depression and pain in patients with arthritis; however, the real relationship between developing depressive symptoms and the risk of arthritis might have been masked in the literature.[41],[42],[43]

The present findings cannot be compared with previous literature directly because previous studies mainly focused on improved depression symptoms and arthritis.[44] These studies also focused on specific outcomes such as functional well-being, pain level, and disability and did not focus on the association between developing depressive symptoms and the risk of arthritis. As noted in the introduction, a cross-sectional general population study that was conducted in Switzerland reported that depressive symptoms were associated with arthritis after controlling for age, sex, education, occupation, and household income. However, the present study focused on the development of depressive symptoms; therefore, the current study findings may help guide clinicians on the effectiveness of depression treatment.

The current study has much strength including the use of longitudinal study design and the validated and widely used 20-item CES-D. Further, the survival analyses employed data from a publicly and privately funded, multicenter, ongoing, longitudinal prospective cohort study. However, some study limitations need to be acknowledged when interpreting the findings. Social desirability bias and recall bias are plausible, as doctor-diagnosed arthritis was self-reported by respondents. This study also did not assess if participants received treatment or medication for depression.

Despite these limitations, the current findings warrant that treating depressive symptoms may decrease the longitudinal risk of developing arthritis. For example, antidepressant treatment was found to reduce depressive symptoms in the general population,[45],[46] and it may also improve their HRQoL. Studies have also reported that the combination of psychotherapy and antidepressants is more effective in treating significant depressive symptoms.[47],[48] Moreover, the Improving Mood-Promoting Access to Collaborative Treatment trial reported that patients with arthritis receiving a combination of antidepressants and psychotherapy showed a reduction in depressive symptoms, pain, and improved HRQoL.[44] Hence, addressing the effects of depression treatment in individuals with coexisting depressive symptoms and arthritis is warranted in the community and population-based studies.


   Conclusion Top


In both men and women, developing depressive symptoms increased the risk of arthritis. There was a significantly lower survival probability at each time point throughout the study among men and women who developed depressive symptoms. Future studies are needed to examine the factors that cause developing depressive symptoms and the mechanism behind the association between depressive symptoms and arthritis.

Acknowledgment

The OAI is a public–private partnership comprised of five contracts (N01-AR-2-2258, N01-AR-2-2259, N01-AR-2-2260, N01-AR-2-2261, and N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. This manuscript was prepared using an OAI public use dataset and does not necessarily reflect the opinions or views of the OAI investigators, the NIH, or the private funding partners.

Financial support and sponsorship

The author extends his appreciation to the Research Centre, College of Applied Medical Sciences, and the Deanship of Scientific Research at King Saud University for supporting this research.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jönsson B, et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011;21:655-79.  Back to cited text no. 1
    
2.
Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, et al. The global burden of mental disorders: An update from the WHO world mental health (WMH) surveys. Epidemiol Psichiatr Soc 2009;18:23-33.  Back to cited text no. 2
    
3.
Felger JC, Lotrich FE. Inflammatory cytokines in depression: Neurobiological mechanisms and therapeutic implications. Neuroscience 2013;246:199-229.  Back to cited text no. 3
    
4.
Sharma A. Systems genomics support for immune and inflammation hypothesis of depression. Curr Neuropharmacol 2016;14:749-58.  Back to cited text no. 4
    
5.
Jansen R, Penninx BW, Madar V, Xia K, Milaneschi Y, Hottenga JJ, et al. Gene expression in major depressive disorder. Mol Psychiatry 2016;21:339-47.  Back to cited text no. 5
    
6.
Dickens C, McGowan L, Clark-Carter D, Creed F. Depression in rheumatoid arthritis: A systematic review of the literature with meta-analysis. Psychosom Med 2002;64:52-60.  Back to cited text no. 6
    
7.
Rodic D, Meyer AH, Meinlschmidt G. The association between depressive symptoms and physical diseases in Switzerland: A cross-sectional general population study. Front Public Health 2015;3:47.  Back to cited text no. 7
    
8.
Katon WJ. Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues Clin Neurosci 2011;13:7-23.  Back to cited text no. 8
    
9.
Kawada T. The prevalence of depression in rheumatoid arthritis: A systematic review and meta-analysis. Rheumatology (Oxford) 2014;53:578.  Back to cited text no. 9
    
10.
Bindawas SM, Snih SA, Grady JJ, Protas EJ, Graham JE, Markides KS, et al. Evidence of reduced health-related quality of life in older Mexican Americans with arthritis. Ethn Dis 2011;21:230-6.  Back to cited text no. 10
    
11.
Song J, Chang RW, Dunlop DD. Population impact of arthritis on disability in older adults. Arthritis Rheum 2006;55:248-55.  Back to cited text no. 11
    
12.
Covinsky KE, Lindquist K, Dunlop DD, Gill TM, Yelin E. Effect of arthritis in middle age on older-age functioning. J Am Geriatr Soc 2008;56:23-8.  Back to cited text no. 12
    
13.
Song J, Chang HJ, Tirodkar M, Chang RW, Manheim LM, Dunlop DD. Racial/ethnic differences in activities of daily living disability in older adults with arthritis: A longitudinal study. Arthritis Rheum 2007;57:1058-66.  Back to cited text no. 13
    
14.
Barbour KE, Helmick CG, Boring M, Brady TJ. Vital signs: Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation – United States, 2013-2015. MMWR Morb Mortal Wkly Rep 2017;66:246-53.  Back to cited text no. 14
    
15.
Rifbjerg-Madsen S, Christensen AW, Christensen R, Hetland ML, Bliddal H, Kristensen LE, et al. Pain and pain mechanisms in patients with inflammatory arthritis: A Danish nationwide cross-sectional DANBIO registry survey. PLoS One 2017;12:e0180014.  Back to cited text no. 15
    
16.
Hill CL, Parsons J, Taylor A, Leach G. Health related quality of life in a population sample with arthritis. J Rheumatol 1999;26:2029-35.  Back to cited text no. 16
    
17.
Stubbs B, Veronese N, Vancampfort D, Thompson T, Kohler C, Schofield P, et al. Lifetime self-reported arthritis is associated with elevated levels of mental health burden: A multi-national cross sectional study across 46 low-and middle-income countries. Sci Rep 2017;7:7138.  Back to cited text no. 17
    
18.
Rathbun AM, Harrold LR, Reed GW. Temporal effect of depressive symptoms on the longitudinal evolution of rheumatoid arthritis disease activity. Arthritis Care Res (Hoboken) 2015;67:765-75.  Back to cited text no. 18
    
19.
Lethbridge-Cejku M, Helmick CG, Popovic JR. Hospitalizations for arthritis and other rheumatic conditions: Data from the 1997 national hospital discharge survey. Med Care 2003;41:1367-73.  Back to cited text no. 19
    
20.
Hootman JM, Helmick CG, Schappert SM. Magnitude and characteristics of arthritis and other rheumatic conditions on ambulatory medical care visits, United States, 1997. Arthritis Rheum 2002;47:571-81.  Back to cited text no. 20
    
21.
Shah D, Rai P, Dwibedi N, Sambamoorthi U. Treatment for depression and health-related quality of life among adults with arthritis. Psychiatr Q 2018;89:129-40.  Back to cited text no. 21
    
22.
Di Giuseppe D, Orsini N, Alfredsson L, Askling J, Wolk A. Cigarette smoking and smoking cessation in relation to risk of rheumatoid arthritis in women. Arthritis Res Ther 2013;15:R56.  Back to cited text no. 22
    
23.
Crowson CS, Matteson EL, Davis JM 3rd, Gabriel SE. Contribution of obesity to the rise in incidence of rheumatoid arthritis. Arthritis Care Res (Hoboken) 2013;65:71-7.  Back to cited text no. 23
    
24.
Rathbun AM, Harrold LR, Reed GW. A prospective evaluation of the effects of prevalent depressive symptoms on disease activity in rheumatoid arthritis patients treated with biologic response modifiers. Clin Ther 2016;38:1759-1772.e3.  Back to cited text no. 24
    
25.
Rathbun AM, Harrold LR, Reed GW. Temporal associations between the different domains of rheumatoid arthritis disease activity and the onset of patient-reported depressive symptoms. Clin Rheumatol 2015;34:653-63.  Back to cited text no. 25
    
26.
Holla JF, van Beers-Tas MH, van de Stadt LA, Landewé R, Twisk JW, Dekker J, et al. Depressive mood and low social support are not associated with arthritis development in patients with seropositive arthralgia, although they predict increased musculoskeletal symptoms. RMD Open 2018;4:e000653.  Back to cited text no. 26
    
27.
Lee JE, Kahana B, Kahana E. Social support and cognitive functioning as resources for elderly persons with chronic arthritis pain. Aging Ment Health 2016;20:370-9.  Back to cited text no. 27
    
28.
Fawaz-Estrup F. The osteoarthritis initiative: An overview. Med Health R I 2004;87:169-71.  Back to cited text no. 28
    
29.
Siddaway AP, Wood AM, Taylor PJ. The center for epidemiologic studies-depression (CES-D) scale measures a continuum from well-being to depression: Testing two key predictions of positive clinical psychology. J Affect Disord 2017;213:180-6.  Back to cited text no. 29
    
30.
Barlow JH, Wright CC. Dimensions of the center of epidemiological studies-depression scale for people with arthritis from the UK. Psychol Rep 1998;83:915-9.  Back to cited text no. 30
    
31.
Smarr KL, Keefer AL. Measures of depression and depressive symptoms: Beck depression inventory-II (BDI-II), center for epidemiologic studies depression scale (CES-D), geriatric depression scale (GDS), hospital anxiety and depression scale (HADS), and patient health questionnaire-9 (PHQ-9). Arthritis Care Res (Hoboken) 2011;63 Suppl 11:S454-66.  Back to cited text no. 31
    
32.
Blalock SJ, DeVellis RF, Brown GK, Wallston KA. Validity of the center for epidemiological studies depression scale in arthritis populations. Arthritis Rheum 1989;32:991-7.  Back to cited text no. 32
    
33.
Miles TP, Flegal K, Harris T. Musculoskeletal disorders: Time trends, comorbid conditions, self-assessed health status, and associated activity limitations. In: Van Nostrand, JF, Furrier SE, Suzman R, editors. Health data on older Americans United States, 1992. Washington: National Center for Health Statistics Vital Health Stat 3; 1993. p. 275-88.  Back to cited text no. 33
    
34.
Martin LG, Soldo BJ. Racial and Ethnic Differences in the Health of Older Americans. Washington (DC): National Academic Press; 1997.  Back to cited text no. 34
    
35.
Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum 2008;58:15-25.  Back to cited text no. 35
    
36.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987;40:373-83.  Back to cited text no. 36
    
37.
Hootman JM, Helmick CG. Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum 2006;54:226-9.  Back to cited text no. 37
    
38.
Dunlop DD, Lyons JS, Manheim LM, Song J, Chang RW. Arthritis and heart disease as risk factors for major depression: The role of functional limitation. Med Care 2004;42:502-11.  Back to cited text no. 38
    
39.
Mella LF, Bértolo MB, Dalgalarrondo P. Depressive symptoms in rheumatoid arthritis. Braz J Psychiatry 2010;32:257-63.  Back to cited text no. 39
    
40.
Dunlop DD, Semanik P, Song J, Manheim LM, Shih V, Chang RW. Risk factors for functional decline in older adults with arthritis. Arthritis Rheum 2005;52:1274-82.  Back to cited text no. 40
    
41.
Husted JA, Tom BD, Farewell VT, Gladman DD. Longitudinal study of the bidirectional association between pain and depressive symptoms in patients with psoriatic arthritis. Arthritis Care Res (Hoboken) 2012;64:758-65.  Back to cited text no. 41
    
42.
Conner TS, Tennen H, Zautra AJ, Affleck G, Armeli S, Fifield J. Coping with rheumatoid arthritis pain in daily life: Within-person analyses reveal hidden vulnerability for the formerly depressed. Pain 2006;126:198-209.  Back to cited text no. 42
    
43.
Schieir O, Thombs BD, Hudson M, Taillefer S, Steele R, Berkson L, et al. Symptoms of depression predict the trajectory of pain among patients with early inflammatory arthritis: A path analysis approach to assessing change. J Rheumatol 2009;36:231-9.  Back to cited text no. 43
    
44.
Lin EH, Katon W, Von Korff M, Tang L, Williams JW Jr., Kroenke K, et al. Effect of improving depression care on pain and functional outcomes among older adults with arthritis: A randomized controlled trial. JAMA 2003;290:2428-9.  Back to cited text no. 44
    
45.
Teh CF, Zaslavsky AM, Reynolds CF 3rd, Cleary PD. Effect of depression treatment on chronic pain outcomes. Psychosom Med 2010;72:61-7.  Back to cited text no. 45
    
46.
Sindrup SH, Otto M, Finnerup NB, Jensen TS. Antidepressants in the treatment of neuropathic pain. Basic Clin Pharmacol Toxicol 2005;96:399-409.  Back to cited text no. 46
    
47.
Knittle K, Maes S, de Gucht V. Psychological interventions for rheumatoid arthritis: Examining the role of self-regulation with a systematic review and meta-analysis of randomized controlled trials. Arthritis Care Res (Hoboken) 2010;62:1460-72.  Back to cited text no. 47
    
48.
Kocsis JH, Rush AJ, Markowitz JC, Borian FE, Dunner DL, Koran LM, et al. Continuation treatment of chronic depression: A comparison of nefazodone, cognitive behavioral analysis system of psychotherapy, and their combination. Psychopharmacol Bull 2003;37:73-87.  Back to cited text no. 48
    

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Correspondence Address:
Dr. Vishal Vennu
Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P. O. Box No. 10219, Riyadh 11433

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_241_18

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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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