title: Major depressive episodes are associated with poor concordance with therapy in rheumatoid arthritis patients: the impact on disease outcomes.
abstract: OBJECTIVE
  Our objective was to investigate associations between major depressive episodes (MDE), concordance with therapy (CwT) and disease outcomes in rheumatoid arthritis patients.
  
  
  METHODS
  Seventy-eight outpatients receiving ≥1 disease modifying anti-rheumatic drug and without significant comorbidity had concomitant rheumatic and psychiatric evaluations. CwT was defined according to a questionnaire. MDE was defined using the Mini International Neuropsychiatric Interview and the severity of depressive symptoms was assessed with the Beck Depression Inventory (BDI-II). Appropriated statistic was used. IRB approval was obtained.
  
  
  RESULTS
  Patients included (73 ♀) had (mean±SD) age of 44±10 years and (median, range) disease duration of 10 years (5.2-15.8). Current MDE were diagnosed in 24 patients (30.8%); 60 patients (76.9%) were CwT. Patient-non-CwT were more frequently diagnosed with MDE and tend to have higher BDI scores. They had significantly more disease activity according to patient-pain VAS and swollen joint counts. Both groups were similar regarding demographic variables, treatment and comorbid conditions. Forty-one patients (53%) had clinically important depressive symptoms (BDI≥10), among them 20 had mild depression, 14 moderate and 7 severe depression. Patient-non-CwT had more frequently moderate depression (according to BDI score) than their counterparts and similar tendency was found regarding severe depression. Patient-CwT who additionally had lower BDI scores had better disease outcomes than concordant patients with higher BDI scores. Similar results were found in non-CwT patients but statistical significance was limited to disease activity.
  
  
  CONCLUSIONS
  Prevalence of current MDE in RA patients was of 31%; those patients had poorer CwT and worse outcomes than mentally healthy patients.
authors.affiliation: Department of Internal Medicine, Instituto Nacional de Ciencias médicas y Nutrición Salvador Zubirán, Mexico DF, Mexico. mar_rocks@hotmail.com.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Cabrera-Marroquín
authors.forename: Irazú
authors.initials: I
authors.lastname: Contreras-Yáñez
authors.forename: Natasha
authors.initials: N
authors.lastname: Alcocer-Castillejos
authors.forename: Virginia
authors.initials: V
authors.lastname: Pascual-Ramos
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents