Depression and increase in depressive symptoms associated with all-cause mortality in rheumatoid arthritis

   Depression and an increase in depressive symptoms are significant risk factors for all-cause mortality in rheumatoid arthritis (RA). Men with either of these characteristics are particularly at risk.

   Researchers at the University of Twente, Netherlands, and the University of California at San Francisco studied the risk of mortality from depression in RA, which has received little attention. 

   In bivariate analyses of data derived from a longitudinal cohort study of individuals with RA recruited from community rheumatology practices and interviewed annually by telephone, the researchers found that depression was associated with an increased risk of death (hazard ratio [HR] 3.5; 95% confidence interval [CI], 2.1 to 5.8]).  

   Worsening of the 15-item Geriatric Depression Scale (GDS) score by >/=2 points was also associated with an increased mortality risk (HR 2.5, CI, 1.5 to 4.2). Controlling for covariates, both depression and an increase in GDS remained significant predictors of mortality. Further, interaction models showed men with depression had five times the risk of death compared to women with no depression. Men without depression also had a greater mortality risk than women with no depression after controlling for covariates, the investigators also noted.