FRI0076 RELATIONSHIP BETWEEN DEPRESSION, LEARNED HELPLESSNESS, DISABILITY AND DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: L. Santoyo-Fexas, R. A. Uriarte Botello, C. V. Solis, J. A. Esquivel Valerio, R. E. Díaz-García, I. J. Colunga-Pedraza, J. A. Icazbalceta-De la Peña, D. Á. Galarza-Delgado
Journal: Annals of the Rheumatic Diseases (2020)

Background: Rheumatoid Arthritis (RA) has been associated with depression by up to 46% (1) Within the universe of manifestations of depression is learned helplessness (LH) LH is defined as an inadequate perception of the disease, generating feelings of defenselessness, loss of self-esteem, pessimism, and negativity. This leads to passivity, surrendering to fate, and thoughts that nothing within their power can change their situation, this condition produces a rapid deterioration which prevents responding adaptively to a traumatic situation, increasing the frequency of anxiety and depression. (2) Objectives: To assess the relationship between depression, LH, disability and disease activity among patients with RA Methods: Descriptive observational study included RA patients diagnosed according to ACR / EULAR 2010 randomly recruited between June and September 2019 at University Hospital “Dr. José Eleuterio González” in Monterrey, México. Beck Depression Inventory (BDI) and Rheumatology Attitude Index (RAI) were applied for measure depression and LH, to measure disability Health Assessment Questionnaire (HAQ-DI) was applied. CDAI and DAS28-PCR scales were used for measure disease activity. Descriptive analysis was carried out with measures of central tendency and dispersion. Spearman correlation were used for comparisons, according to the distribution of the variables. A p &lt;0.05 was considered statistically significant. Results: A total of 177 patients were included, demographic and clinic features are presented in table 1. Prevalence of LH was 94.5% (167/177); 60% (100/167) mild levels (9-15) and 33% (67/167) high levels (&gt;15). A significant correlation was found between higher levels of dysfunctionality and BDI and higher levels of LH (rho = 0.338; p = 0.001). There was a positive association when measuring CDAI (rho = 0.235; p = 0.002) BDI (rho=0.278 P=&lt;0.001) and DAS28-PCR (rho=0.166; p=0.027) with higher levels of LH. There was no association found between other variables as gender, years of diagnosis of RA, years of study or presence of comorbidities like fibromyalgia or osteoarthritis. Table 1. Demographic and clinical characteristics of the patients. HAQ-DI Health Assessment Questionnaire RAI Rheumatology attitude index, DAS28-PCR Disease Activity Score CDAI Clinical disease activity index BDI Beck Depression Inventory Demographics n = 177 Gender Female n, % 165 (93.3%). Male n, % 12 (6.8%) Age (mean), SD. 52.16 (12.8) Years of study (average), SD. 8.3 (3.6) Years with RA (mean), SD. 8.2 (8.0) RAI (mean), SD 13.83 (3.9) HAQ-DI (mean), SD 0.67 (0.77) CDAI (mean), SD 12.0 (11.4) DAS28-PCR (mean), SD 2.4 (0.6) BDI (mean), DE 9.30 (9.7) LH, n (%) 168/177 (94.5%) High levels 108/177 (61%) Low levels 60/177 (33%) Conclusion: In this study the prevalence of LH was high &gt;90%, mainly in mild levels. Dysfunctionality seems to be the factor most associated with the presence of depression and LH. Rheumatologist should consider the high levels of LH, to assess patients in order to obtain a better outcome. Table 2. Correlation between learned helplessness and clinical variables LH Learned Helplessness HAQ-DI Health Assessment Questionnaire RAI Rheumatology Attitude Index DAS28-PCR Disease Activity Score CDAI Clinical Disease Activity Index BDI Beck Depression Inventory rho p LH –HAQ-DI 0.338 &lt;0.001 LH-CDAI 0.235 0.002 LH-DAS28PCR 0.166 0.027 LH-BDI 0.278 &lt;0.001 [1]Margaretten M, Julian L, Katz P, Yelin E. Depression in patients with rheumatoid arthritis: description, causes and mechanisms. Int J Clin Rheumtol. 2011;6(6):617-23. [2]Moyano S, Scolnik M, Vergara F, Garcia MV, Sabelli MR, Rosa JE, et al. Evaluation of Learned Helplessness, Perceived Self-efficacy, and Functional Capacity in Patients With Fibromyalgia and Rheumatoid Arthritis. J Clin Rheumatol. 2019;25(2):65-8. Disclosure of Interests: None declared