The Relationship between Mental Health, Disease Severity, and Genetic Risk for Depression in Early Rheumatoid Arthritis

Jack Euesden; Faith Matcham; Matthew Hotopf; Sophia Steer; Andrew P. Cope; Cathryn M. Lewis; Ian C. Scott

doi:10.1097/PSY.0000000000000462

The Relationship between Mental Health, Disease Severity, and Genetic Risk for Depression in Early Rheumatoid Arthritis

Jack Euesden
, Faith Matcham
, Matthew Hotopf
, Sophia Steer
, Andrew P. Cope
, Cathryn M. Lewis
, Ian C. Scott

Research output: Contribution to journal › Article › peer-review

44 Scopus citations

Abstract

Objective Reduced mental health (MH) is prevalent in rheumatoid arthritis (RA). Although longitudinal studies are limited, there is evidence that depression is associated with worse disease outcomes. We evaluated reciprocal relationships between MH, RA severity, and genetic risks for depression for 2 years in a well-characterized cohort of RA patients. Methods We evaluated 520 early RA patients previously enrolled to two clinical trials. MH was measured using the short form-36 MH domain and mental component summary scores (MCS). MCS/MH associations over 2 years with disease activity (disease activity score on a 28-joint count), disability (health assessment questionnaire), pain visual analog scale scores, and a weighted genetic risk score for depression were tested using linear mixed-effects and regression models. Results Poorer MH was associated with worse RA outcomes. Lower MCS scores (indicating worse MH) were seen in patients with a greater genetic risk for depression (weighted genetic risk score: Coefficient =-1.21, p =.013). Lower baseline MCS was associated with lower 2-year improvements in disease activity score on a 28-joint count (coefficient =-0.02, p <.001), pain (coefficient =-0.33, p <.001), and health assessment questionnaire (coefficient =-0.01, p =.006). Baseline MCS was associated with changes in the swollen joint count (coefficient =-0.09, p <.001) and patient global assessment (coefficient =-0.28, p <.001) but not the tender joint count (p =.983) and erythrocyte sedimentation rate (p =.973). Only baseline pain visual analog scale (coefficient =-0.07, p =.002) was associated with 2-year changes in MCS. Conclusions Reduced baseline MH was associated with lower improvements in disease activity, disability, and pain for 2 years, supporting current national guidelines recommending screening for depression in RA. Pain had a bidirectional relationship with MH. Depression genetic risk had a significant association with MH.

Original language	English
Pages (from-to)	638-645
Number of pages	8
Journal	Psychosomatic Medicine
Volume	79
Issue number	6
DOIs	https://doi.org/10.1097/PSY.0000000000000462
State	Published - 1 Jul 2017
Externally published	Yes

Keywords

CARDERA = Combination Anti-Rheumatic Drugs in Early RA
CBT = cognitive-behavioral therapy
DAS28 = disease activity score on a 28-joint count
ESR = erythrocyte sedimentation rate
GWAS = genome-wide association study
HAQ = health assessment questionnaire
HRQoL = health-related quality of life
HWE = Hardy-Weinberg equilibrium
Key words/Abbreviations
LOCF = last observation carried forward
MAF = minor allele frequency
MCS = mental component summary score
MDD = major depressive disorder
MH = mental health
PGA = patient global assessment
RA = rheumatoid arthritis
RCT = randomized controlled trial
REC = Research Ethics Committee
RF = rheumatoid factor
SE = standard error
SF-36 = short form-36
SJC = swollen joint count
SNP = single nucleotide polymorphism
TJC = tender joint count
VAS = visual analog scale
disability
disease activity
genetics
mental health
p = p value threshold
pain
rheumatoid arthritis
wGRS = weighted genetic risk score

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10.1097/PSY.0000000000000462

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@article{e72dd9e41497463285ba4ff49d7b0302,

title = "The Relationship between Mental Health, Disease Severity, and Genetic Risk for Depression in Early Rheumatoid Arthritis",

abstract = "Objective Reduced mental health (MH) is prevalent in rheumatoid arthritis (RA). Although longitudinal studies are limited, there is evidence that depression is associated with worse disease outcomes. We evaluated reciprocal relationships between MH, RA severity, and genetic risks for depression for 2 years in a well-characterized cohort of RA patients. Methods We evaluated 520 early RA patients previously enrolled to two clinical trials. MH was measured using the short form-36 MH domain and mental component summary scores (MCS). MCS/MH associations over 2 years with disease activity (disease activity score on a 28-joint count), disability (health assessment questionnaire), pain visual analog scale scores, and a weighted genetic risk score for depression were tested using linear mixed-effects and regression models. Results Poorer MH was associated with worse RA outcomes. Lower MCS scores (indicating worse MH) were seen in patients with a greater genetic risk for depression (weighted genetic risk score: Coefficient =-1.21, p =.013). Lower baseline MCS was associated with lower 2-year improvements in disease activity score on a 28-joint count (coefficient =-0.02, p <.001), pain (coefficient =-0.33, p <.001), and health assessment questionnaire (coefficient =-0.01, p =.006). Baseline MCS was associated with changes in the swollen joint count (coefficient =-0.09, p <.001) and patient global assessment (coefficient =-0.28, p <.001) but not the tender joint count (p =.983) and erythrocyte sedimentation rate (p =.973). Only baseline pain visual analog scale (coefficient =-0.07, p =.002) was associated with 2-year changes in MCS. Conclusions Reduced baseline MH was associated with lower improvements in disease activity, disability, and pain for 2 years, supporting current national guidelines recommending screening for depression in RA. Pain had a bidirectional relationship with MH. Depression genetic risk had a significant association with MH.",

keywords = "CARDERA = Combination Anti-Rheumatic Drugs in Early RA, CBT = cognitive-behavioral therapy, DAS28 = disease activity score on a 28-joint count, ESR = erythrocyte sedimentation rate, GWAS = genome-wide association study, HAQ = health assessment questionnaire, HRQoL = health-related quality of life, HWE = Hardy-Weinberg equilibrium, Key words/Abbreviations, LOCF = last observation carried forward, MAF = minor allele frequency, MCS = mental component summary score, MDD = major depressive disorder, MH = mental health, PGA = patient global assessment, RA = rheumatoid arthritis, RCT = randomized controlled trial, REC = Research Ethics Committee, RF = rheumatoid factor, SE = standard error, SF-36 = short form-36, SJC = swollen joint count, SNP = single nucleotide polymorphism, TJC = tender joint count, VAS = visual analog scale, disability, disease activity, genetics, mental health, p = p value threshold, pain, rheumatoid arthritis, wGRS = weighted genetic risk score",

author = "Jack Euesden and Faith Matcham and Matthew Hotopf and Sophia Steer and Cope, \{Andrew P.\} and Lewis, \{Cathryn M.\} and Scott, \{Ian C.\}",

note = "Publisher Copyright: {\textcopyright} 2017 Lippincott Williams \& Wilkins.",

year = "2017",

month = jul,

day = "1",

doi = "10.1097/PSY.0000000000000462",

language = "English",

volume = "79",

pages = "638--645",

journal = "Psychosomatic Medicine",

issn = "0033-3174",

publisher = "Lippincott Williams and Wilkins",

number = "6",

}

TY - JOUR

T1 - The Relationship between Mental Health, Disease Severity, and Genetic Risk for Depression in Early Rheumatoid Arthritis

AU - Euesden, Jack

AU - Matcham, Faith

AU - Hotopf, Matthew

AU - Steer, Sophia

AU - Cope, Andrew P.

AU - Lewis, Cathryn M.

AU - Scott, Ian C.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Objective Reduced mental health (MH) is prevalent in rheumatoid arthritis (RA). Although longitudinal studies are limited, there is evidence that depression is associated with worse disease outcomes. We evaluated reciprocal relationships between MH, RA severity, and genetic risks for depression for 2 years in a well-characterized cohort of RA patients. Methods We evaluated 520 early RA patients previously enrolled to two clinical trials. MH was measured using the short form-36 MH domain and mental component summary scores (MCS). MCS/MH associations over 2 years with disease activity (disease activity score on a 28-joint count), disability (health assessment questionnaire), pain visual analog scale scores, and a weighted genetic risk score for depression were tested using linear mixed-effects and regression models. Results Poorer MH was associated with worse RA outcomes. Lower MCS scores (indicating worse MH) were seen in patients with a greater genetic risk for depression (weighted genetic risk score: Coefficient =-1.21, p =.013). Lower baseline MCS was associated with lower 2-year improvements in disease activity score on a 28-joint count (coefficient =-0.02, p <.001), pain (coefficient =-0.33, p <.001), and health assessment questionnaire (coefficient =-0.01, p =.006). Baseline MCS was associated with changes in the swollen joint count (coefficient =-0.09, p <.001) and patient global assessment (coefficient =-0.28, p <.001) but not the tender joint count (p =.983) and erythrocyte sedimentation rate (p =.973). Only baseline pain visual analog scale (coefficient =-0.07, p =.002) was associated with 2-year changes in MCS. Conclusions Reduced baseline MH was associated with lower improvements in disease activity, disability, and pain for 2 years, supporting current national guidelines recommending screening for depression in RA. Pain had a bidirectional relationship with MH. Depression genetic risk had a significant association with MH.

AB - Objective Reduced mental health (MH) is prevalent in rheumatoid arthritis (RA). Although longitudinal studies are limited, there is evidence that depression is associated with worse disease outcomes. We evaluated reciprocal relationships between MH, RA severity, and genetic risks for depression for 2 years in a well-characterized cohort of RA patients. Methods We evaluated 520 early RA patients previously enrolled to two clinical trials. MH was measured using the short form-36 MH domain and mental component summary scores (MCS). MCS/MH associations over 2 years with disease activity (disease activity score on a 28-joint count), disability (health assessment questionnaire), pain visual analog scale scores, and a weighted genetic risk score for depression were tested using linear mixed-effects and regression models. Results Poorer MH was associated with worse RA outcomes. Lower MCS scores (indicating worse MH) were seen in patients with a greater genetic risk for depression (weighted genetic risk score: Coefficient =-1.21, p =.013). Lower baseline MCS was associated with lower 2-year improvements in disease activity score on a 28-joint count (coefficient =-0.02, p <.001), pain (coefficient =-0.33, p <.001), and health assessment questionnaire (coefficient =-0.01, p =.006). Baseline MCS was associated with changes in the swollen joint count (coefficient =-0.09, p <.001) and patient global assessment (coefficient =-0.28, p <.001) but not the tender joint count (p =.983) and erythrocyte sedimentation rate (p =.973). Only baseline pain visual analog scale (coefficient =-0.07, p =.002) was associated with 2-year changes in MCS. Conclusions Reduced baseline MH was associated with lower improvements in disease activity, disability, and pain for 2 years, supporting current national guidelines recommending screening for depression in RA. Pain had a bidirectional relationship with MH. Depression genetic risk had a significant association with MH.

KW - CARDERA = Combination Anti-Rheumatic Drugs in Early RA

KW - CBT = cognitive-behavioral therapy

KW - DAS28 = disease activity score on a 28-joint count

KW - ESR = erythrocyte sedimentation rate

KW - GWAS = genome-wide association study

KW - HAQ = health assessment questionnaire

KW - HRQoL = health-related quality of life

KW - HWE = Hardy-Weinberg equilibrium

KW - Key words/Abbreviations

KW - LOCF = last observation carried forward

KW - MAF = minor allele frequency

KW - MCS = mental component summary score

KW - MDD = major depressive disorder

KW - MH = mental health

KW - PGA = patient global assessment

KW - RA = rheumatoid arthritis

KW - RCT = randomized controlled trial

KW - REC = Research Ethics Committee

KW - RF = rheumatoid factor

KW - SE = standard error

KW - SF-36 = short form-36

KW - SJC = swollen joint count

KW - SNP = single nucleotide polymorphism

KW - TJC = tender joint count

KW - VAS = visual analog scale

KW - disability

KW - disease activity

KW - genetics

KW - mental health

KW - p = p value threshold

KW - pain

KW - rheumatoid arthritis

KW - wGRS = weighted genetic risk score

UR - https://www.scopus.com/pages/publications/85014798422

U2 - 10.1097/PSY.0000000000000462

DO - 10.1097/PSY.0000000000000462

M3 - Article

C2 - 28282363

AN - SCOPUS:85014798422

SN - 0033-3174

VL - 79

SP - 638

EP - 645

JO - Psychosomatic Medicine

JF - Psychosomatic Medicine

IS - 6

ER -

The Relationship between Mental Health, Disease Severity, and Genetic Risk for Depression in Early Rheumatoid Arthritis

Abstract

Keywords

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