title: Systematic Review and Meta-analysis of Interventions for Depression and Anxiety in Persons With Rheumatoid Arthritis.
abstract: BACKGROUND
  Psychiatric comorbidities, such as depression and anxiety, are very common in persons with rheumatoid arthritis (RA) and can lead to adverse outcomes. By appropriately treating these comorbidities, disease-specific outcomes and quality of life may be improved.
  
  
  OBJECTIVE
  The aim of this study was to systematically review the literature from controlled trials of treatments for depression and anxiety in persons with RA.
  
  
  METHODS
  We searched multiple online databases from inception until March 25, 2015, without restrictions on language, date, or location of publication. We included controlled trials conducted in persons with RA and depression or anxiety. Two independent reviewers extracted information including trial and participant characteristics. The standardized mean differences (SMDs) of depression or anxiety scores at postassessment were pooled between treatment and comparison groups, stratified by active versus inactive comparators.
  
  
  RESULTS
  From 1291 unique abstracts, we included 8 RA trials of depression interventions (6 pharmacological, 1 psychological, 1 both). Pharmacological interventions for depression with inactive comparators (n = 3 trials, 143 participants) did not reduce depressive symptoms (SMD, -0.21; 95% confidence interval [CI], -1.27 to 0.85), although interventions with active comparators (n = 3 trials, 190 participants) did improve depressive symptoms (SMD, -0.79; 95% CI, -1.34 to -0.25). The single psychological trial of depression treatment in RA did not improve depressive symptoms (SMD, -0.44; 95% CI, -0.96 to 0.08). Seven of the trials had an unclear risk of bias.
  
  
  CONCLUSIONS
  Few trials examining interventions for depression or anxiety in adults with RA exist, and the level of evidence is low to moderate because of the risk of bias and small number of trials.
authors.forename: Kirsten M
authors.initials: KM
authors.lastname: Fiest
authors.forename: Carol A
authors.initials: CA
authors.lastname: Hitchon
authors.forename: Charles N
authors.initials: CN
authors.lastname: Bernstein
authors.forename: Christine A
authors.initials: CA
authors.lastname: Peschken
authors.forename: John R
authors.initials: JR
authors.lastname: Walker
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Graff
authors.forename: Ryan
authors.initials: R
authors.lastname: Zarychanski
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abou-Setta
authors.forename: Scott B
authors.initials: SB
authors.lastname: Patten
authors.forename: Jitender
authors.initials: J
authors.lastname: Sareen
authors.forename: James
authors.initials: J
authors.lastname: Bolton
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Marrie
mesh_terms: D001007:Anxiety / Q000503:physiopathology / Q000628:therapy; D001172:Arthritis, Rheumatoid / Q000523:psychology*; D003863:Depression / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D011580:Psychological Techniques; D011788:Quality of Life