Original Research

Prevalence of depressive symptoms in patients with rheumatoid arthritis at a regional hospital in KwaZulu-Natal, South Africa

Mfundo Mabusela, Andrew Tomita, Saeeda Paruk, Farhanah Paruk
South African Journal of Psychiatry | Vol 28 | a1702 | DOI: https://doi.org/10.4102/sajpsychiatry.v28i0.1702 | © 2022 Mfundo Mabusela, Andrew Tomita, Saeeda Paruk, Farhanah Paruk | This work is licensed under CC Attribution 4.0
Submitted: 28 February 2021 | Published: 22 February 2022

About the author(s)

Mfundo Mabusela, Department of Internal Medicine, Faculty of Medicine, University of KwaZulu-Natal, Durban, South Africa
Andrew Tomita, Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; and, KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Saeeda Paruk, Department of Psychiatry, Faculty of Medicine, University of KwaZulu-Natal, Durban, South Africa
Farhanah Paruk, Department of Rheumatology, Faculty of Medicine, University of KwaZulu-Natal, Durban, South Africa


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Abstract

Background: Depression affects 14.8% – 38.8% of patients with rheumatoid arthritis (RA) in developed countries. The prevalence and risk factors for depression in patients with RA in sub-Saharan Africa is not well established.

Aim: To determine the prevalence of depressive symptoms in patients with RA.

Setting: Public sector regional hospital in South Africa.

Methods: A cross-sectional descriptive study was undertaken with 110 adult RA patients. A structured socio-demographic and clinical questionnaire, the modified health assessment questionnaire (mHAQ), the simplified disease activity index (SDAI) for RA, the patient health questionnaire (PHQ-9), and the Household Food Insecurity Access scale (HFIAS) for nutritional status, were used. Correlates of depressive symptomatology in participants with RA were identified using t-tests and regression analyses.

Results: Most of the participants were women (90.9%), 67% had moderate to severe RA disease on the SDAI score, 92.7% reported functional disability (HAQ score of ≥ 1), and 87.2% reported mild to severe depressive symptoms. Unemployment (p < 0.01), severe food insecurity (p < 0.01) and functional disability (p = 0.02), were significantly associated with the depressive symptoms, but not with disease activity (p = 0.8) or inflammatory markers (p = 0.63). Unemployment (adjusted β = −5.07, p < 0.01) and severe food insecurity (adjusted β = −4.47, p < 0.01) were significantly associated with depressive symptoms, based on the adjusted regression model.

Conclusion: As RA effects functional status, with the impact of the resulting unemployment and food insecurity being associated with depression, affected people should be screened for depression and managed using a multidisciplinary approach, especially considering the role of social determinants in RA patients with depression.


Keywords

rheumatoid arthritis; disease activity; depression; functional impairment; food insecurity

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