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Defining depression and anxiety in individuals with rheumatic diseases using administrative health databases: A systematic review

A recent research titled “Defining Depression and Anxiety in Individuals with Rheumatic Diseases Using Administrative Health Databases: A Systematic Review” identified numerous case definitions used to evaluate depression and anxiety among individuals with rheumatic diseases within administrative health databases. Administrative health databases are defined as the secondary data collected for billing purposes, which can comprise of several unique administrative data sources, including the number of inpatient visits, outpatient visits, and prescription claims (these data are often linked at the individual level).

The researchers concluded that identifying depression and anxiety within administrative health databases presents challenges such as misclassification – various definitions have been used to define these mental illnesses. The use of numerous case definitions to assess mental illness may affect the actual number of patients living with mental illness. One study showed that prevalence estimates of comorbid mental illnesses in individuals with diabetes can range from 13% to 34% depending on the coding algorithm being used.

According to the research paper, “A total of 36 studies included in this review assessed depression and 13 evaluated anxiety. Three studies combined multiple psychiatric diagnoses into a single variable, specifically: anxiety and depression (22), psychosis and depression (23), and affective/neurotic disorders (24). In addition, one study combined depression and insomnia into a single primary outcome (25). Anxiety and depression were evaluated as a primary outcome in 18 studies, as an exposure in four studies, and as both a primary outcome and exposure in one study. Lastly, there were 13 studies that included anxiety and depression as a covariate or comorbidity in their analyses. “

Administrative health data, which characterizes the treatment and diagnosis of only persons who seek care and discuss their mental health, risks underestimating cases of depression and anxiety.

Researchers from the study recommend linking multiple administrative data sources when feasible and exploring the use of validated case definitions for depression and anxiety.

Depression as a symptom of arthritis:
treatment, coping strategies, and support

Depression as a symptom of arthritis

People living with rheumatoid arthritis are twice as likely as the rest of the population to experience depression. There are several reasons depression occurs in people with rheumatoid arthritis (RA). Sometimes it starts from the shock of diagnosis and finding out that it is an unpredictable disease that can become more painful and debilitating over time. Sometimes depression occurs because of feeling tired and unwell or isolated as a result of the disease. RA can affect the ability to work, look after family, and engage in social activities and interests. The stress that results from either of these situations can trigger depression in those who are predisposed by heredity or other factors.

Some symptoms of RA overlap with those of depression, such as pain, fatigue, and troubles with sleep, making it more difficult for your doctor to diagnose depression. Other symptoms of depression to watch for may include reduced appetite, reduced sex drive, moving or talking slowly, feeling negative or pessimistic, low self-esteem, difficulty concentrating, losing interest in activities once found pleasurable, having suicidal thoughts, and experiencing headaches and body pain.

For someone with rheumatoid arthritis, or any chronic illness, depression can magnify the pain. The combination of these two conditions increases the level of disability, increases mortality rate, and reduces quality of life. Therefore, it is important to treat both rheumatoid arthritis and depression when depression has been determined. Click here to read the full issue of JointHealth™ insight on depression and arthritis.