Depressive and anxiety symptoms and social support are independently associated with disease-specific quality of life in Colombian patients with rheumatoid arthritis

Rogers, Heather L.; Brotherton, Hardin T.; Plaza, Silvia Leonor Olivera; Durán, María Angélica Segura; Altamar, Marvín Leonel Peña

doi:10.1016/j.rbr.2015.01.005

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Original articles • Rev. Bras. Reumatol. 55 (5) • Sep-Oct 2015 • https://doi.org/10.1016/j.rbr.2015.01.005 copy

Depressive and anxiety symptoms and social support are independently associated with disease-specific quality of life in Colombian patients with rheumatoid arthritis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To examine the relationship between disease-specific quality of life (QOL) and socio-demographic, medical, and psychosocial factors in Colombian patients with Rheumatoid Arthritis (RA).

Methods:

One hundred and three RA patients recruited from ambulatory centers in Neiva, Colombia were administered the Disease Activity Scale 28 (DAS-28), QOL-RA, Zung Self-Rating Depression Scale, State-Trait Anxiety Inventory (STAI), Interpersonal Support Evaluation List-12 (ISEL-12), and Symptom Checklist-90 Revised (SCL-90R).

Results:

Lower QOL-RA was associated with lower socio-economic status (r = 0.26, p < 0.01), higher likelihood of using opioids (t = -2.51, p< 0.05), higher likelihood of comorbid pulmonary disease (t = -2.22, p < 0.05), and lower ISEL-12 sub-scales (r's = 0.41-0.31, p's < 0.001). Lower QOL-RA was associated with higher DAS-28 (r = -0.28, p < 0.01), Visual Analog Scale (VAS; r = -0.35, p < 0.001), Zung Depression (r = -0.72, p < 0.001), STAI-State (r = -0.66, p < 0.001), STAI-Trait (r = -0.70, p < 0.001), SCL-90R Global Severity Index (r = -0.50, p < 0.001), SCL-90R Positive Symptom Total (r = -0.57, p < 0.001), and all SCL-90R sub-scales (r's = -0.54 to -0.21, p's < 0.01). A multivariate linear regression model indicated that SES (B = 2.77, p < 0.05), Zung Depression (B = -0.53, p < 0.001), STAI-State (B = -0.26, p < 0.05), and ISEL-12 Belonging (B = 1.15, p< 0.01) were independently associated with QOL-RA, controlling for significant associations.

Conclusions:

More depressive and anxiety symptoms were independently associated with lower disease-specific QOL, while higher perceptions of having people to do activities with (belonging social support) and higher SES were independently associated with higher disease-specific quality of life. Psychosocial factors impact QOL in RA above and beyond disease activity. Additional research into the benefits of psychosocial assessment of RA patients and provision of comprehensive care to improve QOL is warranted.

Keywords:
Rheumatoid arthritis; Quality of life; Depression; Anxiety; Social support

	% (n)	Mean (SD)
Age		53.8 (12.7)
Gender (female)	85.4% (88)

Marital status
Single	12.6% (13)
Married	63.1% (65)
Divorced/separated	12.6% (13)
Widowed	11.7% (12)

Education
Primary/elementary school or less	39.9% (41)
High school	42.7% (44)
Technical studies or degree	10.6% (11)
University studies or degree	6.8% (7)

Socio-economic level
1	17.5% (18)
2	68.0% (70)
3	12.6% (13)
4	1.0% (1)
5	1.0% (1)
6	0.0% (0)

Gainfully employed	36.9% (38)

	% (n)	Mean (SD)
Disease Activity Scale 28 (DAS28)		4.87 (1.46)
Severe (>5.1)	45.6% (47)
Moderate (3.2–5.1)	38.8% (40)
Low (2.6–3.2)	8.7% (9)
Remission (<2.6)	6.8% (7)

Visual Analog Scale (VAS) for DAS28		6.29 (2.68)

Number of years with disease		12.97 (11.63)
Early Rheumatoid Arthritis (≤3 years)	20.4% (21)

Total medications, mean (SD)		3.03 (0.88)
Non-Steroidal Anti-Inflammatory Drugs	91.3% (94)
Disease Modifying Anti-Rheumatic Drugs	77.7% (80)
Steroids	76.7% (79)
None	49.5% (51)
Biologic Therapy	44.7% (46)
Other	5.8% (6)
Opioids	4.9% (5)

Total comorbidities, mean (SD)		0.84 (1.02)
Hypertension	28.2% (29)
Other	21.4% (22)
Cardiac disease	14.6% (15)
Diabetes	8.7% (9)
Pulmonary disease	4.9% (5)

Socio-demographic and medical characteristics	Statistical test value^a a If the independent variable was continuous, r value of a Pearson correlation was provided. If the independent variable was categorical, t value of the independent t test was provided.	p value
Age	-0.03	0.76
Gender	0.38	0.71
Marital status	0.37	0.72
Education	0.13	0.19
Socio-Economic Status^b b p < 0.01.	0.26	0.008
Gainfully employed	-0.57	0.57
Disease Activity Scale 28 (DAS28) score^b b p < 0.01.	-0.28	0.004
Visual Analog Scale DAS28 score^c c p < 0.001.	-0.35	<0.001
Number of years with disease	-0.01	0.96
Early Rheumatoid Arthritis	-0.92	0.36
Total medications	0.03	0.76
Biologic Therapy	1.24	0.22
Disease Modifying Anti-Rheumatic Drugs	0.19	0.85
Steroids	0.21	0.83
Non-Steroidal Anti-Inflammatory Drugs	-1.72	0.11
Opioids^d d p < 0.05.	-2.51	0.014
Other	1.50	0.14
Total comorbidities	-0.05	0.65
None	0.17	0.87
Hypertension	-0.17	0.86
Diabetes	0.44	0.66
Cardiac disease	-0.54	0.59
Pulmonary disease^d d p < 0.05.	-2.22	0.03
Other	1.64	0.10

Psychosocial factor	Statistical test value^a a If the independent variable was continuous, r value of a Pearson correlation was provided. If the independent variable was categorical, t value of the independent t test was provided.	p value
Zung Depression^b b p < 0.001.	-0.72	<0.001
State-Trait Anxiety Inventory-State^b b p < 0.001.	-0.66	<0.001
State-Trait Anxiety Inventory-Trait^b b p < 0.001.	-0.70	<0.001
Interpersonal Support Evaluation List (ISEL) total^b b p < 0.001.	0.42	<0.001
ISEL Appraisal^b b p < 0.001.	0.31	<0.001
ISEL Belonging^b b p < 0.001.	0.41	<0.001
ISEL Tangible^b b p < 0.001.	0.38	<0.001
Symptom Checklist-90-Revised (SCL-90R) Global Severity Index^b b p < 0.001.	-0.50	<0.001
SCL-90R Positive Symptom Total^b b p < 0.001.	-0.57	<0.001
SCL-90R Positive Symptom Distress Index	-0.10	0.33
SCL-90R Somatization^b b p < 0.001.	-0.45	<0.001
SCL-90R Obsessive–Compulsive^b b p < 0.001.	-0.36	<0.001
SCL-90R Interpersonal Sensitivity^b b p < 0.001.	-0.33	<0.001
SCL-90R Depression^b b p < 0.001.	-0.51	<0.001
SCL-90R Anxiety^b b p < 0.001.	-0.54	<0.001
SCL-90R Hostility^b b p < 0.001.	-0.37	<0.001
SCL-90R Phobic Anxiety^b b p < 0.001.	-0.42	<0.001
SCL-90R Paranoid Ideation^c c p < 0.05.	-0.21	0.03
SCL-90R Psychoticism^d d p < 0.01.	-0.30	0.002

Factor	Unstandardized B	Standardized Beta	p value
Socio-Economic Status ^a a p < 0.05.	2.77	0.15	0.01
Disease Activity Scale 28 (DAS28)	-0.52	-0.06	0.45
Visual Analog Scale DAS28 score	-0.08	-0.02	0.84
Opioid use	3.36	0.06	0.33
Pulmonary disease	2.83	0.05	0.39
Zung Depression^b b p < 0.001.	-0.53	-0.32	<0.001
State-Trait Anxiety Inventory – State^a a p < 0.05.	-0.26	-0.22	0.02
State-Trait Anxiety Inventory – Trait	-0.27	-0.21	0.07
Interpersonal Support Evaluation List (ISEL) – Appraisal	-0.60	-0.12	0.18
ISEL Belonging^c c p < 0.01.	1.15	0.23	0.005
ISEL Tangible	0.38	0.07	0.43
Symptom Checklist-90-Revised (SCL-90R) Global Severity Index	8.11	0.24	0.10
SCL-90R Positive Symptom Total	-0.21	-0.26	0.07

Sociedade Brasileira de Reumatologia Av Brigadeiro Luiz Antonio, 2466 - Cj 93., 01402-000 São Paulo - SP, Tel./Fax: 55 11 3289 7165 - São Paulo - SP - Brazil
E-mail: sbre@terra.com.br

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[1] *Corresponding author. E-mail: hrogers@deusto.es(H.L. Rogers).