Symptoms of Depression and Disability among Rheumatoid Arthritis Patients

Background Rheumatoid arthritis (RA) is a significant and serious public illness affecting peoples especially adults all over the world and emotional problems such as depressive symptoms are more common in patients with RA than in general population. Synovial inflammation, joint damage, degeneration of cartilage, bony destruction and limitation of physical functioning are the distinctive feature of RA that consequently leads to functional disability. This study aimed at assesses prevalence of symptoms of depression and disability among RA patients. Research Design: A descriptive correlational research design was utilized in this study. Study subjects: Established diagnosed 80 RA patients were included in the study. Two tools were used; Beck Depression Inventory (BDI) version I to assess symptoms of depression, and Health assessment questionnaire-disability index (HAQ-DI) to assess disease-related disability. Result: Majority of the participants were females with the age of (20-65) y. About two thirds of the studied sample had moderate depressive symptoms, while about three quarters of them have moderate level of disability. There was significant positive correlation between symptoms of depression and disability. Conclusion: More than three quarters of the studied sample had moderate to severe level of depressive symptoms and disability. Recommendation of the study: Frequent assessments of depressive symptoms and disability in RA patients. Key Word: Rheumatoid Arthritis (RA), Depression, Disability Introducti on Rheumatoid arthritis (RA) is a chronic systemic inflammatory autoimmune disease characterized by proliferative inflammation of synovial joints (Kuo et al., 2020). It is common among adults around the world with prevalence rate about 1% of general population and commonly starts between the ages of 30-50 years (Vallerand et al., 2019), the occurrence in Women is two to three times more than men. There is no definite cause of RA; it is thought to involve a variety of factors mainly genetic in addition to environmental factors. RA cannot be cured and its management aimed to achieving remission" few or no symptoms" and maintaining good quality of life (Arthritis Foundation., 2019). Depressive symptoms is known in the rheumatology field as ‘comorbidity’ of RA (Vallerand et al., 2019) that occurs in about 16.8 (10-23%) of patients and this is considered greater than prevalence in general population (Alan et al., 2016). Depressive symptoms in RA may occur as a result of pain and disability which associated with impaired activity, organ dysfunction and altered role performance (Cunha et al., 2016). Also, there is a great evidence that joint pain, fatigue and disability result in physical and psychological stress which lead to disturbance in balance of brain neurotransmitters and hormones like serotonin, norepinephrine and this lead to negative impact on mood, behavior and cognition, that finally increasing the risk of depression (Arthritis Foundation, 2016; Zelman, 2018). According to a different model, depression in RA occur as a result of chronic inflammation from pro-inflammatory cytokine present in RA (Arthritis Foundation., 2016), The presence of depression in the case of RA results in different problems more than the burden of the emotional problem alone (Dures et al., 2014). It is linked with higher incidence of cardiovascular problems, heart attack, suicidal ideation (Tektonidou et al., 2011) increase health service use, impaired quality of life and higher mortality (Matcham, et al., 2016*). RA also, has a great negative effects on patient's quality-of-life (QoL), including physical, mental, social and occupational aspects (Matchamet al., 2014; Qorolli et al., 2019). Health-related quality of life (HRQL) involve physical, emotional, , social and particular feelings of wellbeing which represent the person's evaluation and response to his disease (Fontaine, 2011; Malm et al., 2017). RA is affecting quality of life directly and indirectly, and accounted as the major cause of health service consuming, the main cause of handicap, the first reason for impaired work productivity and early retirement. Pain and physical disability that present in RA accompanied with limited activity, organ deterioration, and impaired social and functional roles resulting, a negative effect on different aspects of patient life (Cunhaa et al., 2016). Poor quality of life in patients with RA is accompanied with increased healthcare resources usage and high risk of depression (Gaber et al., 2013; Gheita et al., 2014). Significance of the study Symptoms of depression has been listed as the most common symptom among psychological problems that negatively impacts patient's life and adversely affects multiple outcomes in RA beyond the burden of mental illness itself (Margaretten et al., 2011). Also RA has a considerable impact on patient's physical health and lead to great limitation in physical activity. Assessing both the physical and psychological symptoms of RA is very important to investigate the association between depression and disability, which considered a useful target for interventions aimed at improving physical and mental health status. Aim of the study This study aimed to assess prevalence of symptoms of depression and disability among RA patients. Subjects and Methods Research design A descriptive correlational research design was utilized in this study. Minia Scientific Nursing Journal (Print) (ISSN 2537-012X) Vol. (7) No. (1) June 2020 P a g e | 74 Ebtsam A. , et al Setting This study was conducted on a cohort of RA patients' recruited from out-patient clinic of Rheumatology and Rehabilitation Department at Minia university hospital. The Hospital serves as central hospital in Minia Governorate and its suburb areas. Subjects A purposive sample established diagnosed 80 RA patients by rheumatologist which equal to 30% from total population size, and the total population size at a previous year was (270) (Mohamed., 2002; Roscoe., 1975). Inclusion Criteria • Patients aged ≥18 years (Adult RA). • Disease duration ≥ one year. • The patient should be adherent to follow up outpatient clinic. Tools of Data Collection A well-designed questionnaire was used to collect the data of the recruited patients. Patient data were obtained from patient's record sheet in Rheumatology outpatient clinic and includes; demographic information: age, gender, educational level, marital status, occupation and clinical data (duration of illness). Tool (I): Beck Depression Inventory (BDI): (BDI) version I developed by Beck (1961), is a 21question multiple-choice self-report inventory measuring the severity of depressive symptoms The questionnaire contains 21 questions about how the subject has been feeling in the last week; each question has a set of at least four possible answer choices, ranging from 0 to 3, indicating the severity of the symptom. Items 1 to 13 assess symptoms that are psychological in nature, while items 14 to 21 assess more physical symptoms (Beck. 1961). The questionnaire back translated to Arabic by Abdelkhalek, (1998), the translated questionnaire had shown a strong validity and reliability. Internal consistency showed a high value for standardized alpha (Cronbach’s) = 0.98 (Damati et al., 2000). Tool (II): The Health Assessment QuestionnaireDisability Index (HAQ-DI): Originally was developed in 1978 by James F. Fries and colleagues at Stanford University as a functional assessment tool measure disease-related disability and discomfort in patients with RA. The questionnaire contains 20 questions grouped into eight subscales as dressing and grooming, arising, eating, walking, hygiene, reach, grip and activities (Fries et al., 1982). The Arabic version of Elmiedany was used. The translated questionnaire had shown a strong validity and reliability. Internal consistency showed a high value for standardized alpha (Cronbach’s): 0.979(El Miedany et al., 2003). The HAQ disability index was calculated as the sum of the scores for various subscales, divided by the number of subscales responded to, and results in a score between (0 and 3). Scores of 0 to 1 is generally represent mild to moderate difficulty, 1 to 2 represents moderate to severe disability, and 2 to 3 indicates severe to very severe disability (Fries et al.,