Burden of Depression among Working-Age Adults with Rheumatoid Arthritis

Abstract

Objective . This study estimated the excess clinical, humanistic, and economic burden associated with depression among working-age adults with Rheumatoid Arthritis (RA). Methods . A retrospective cross-sectional study was conducted among working-age (18 to 64 years) RA patients with depression (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mi>N</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">64</mml:mn><mml:mn fontstyle="italic">7</mml:mn></mml:math>) and without depression (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mi>N</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">2</mml:mn><mml:mtext>,</mml:mtext><mml:mn fontstyle="italic">015</mml:mn></mml:math>) using data from the nationally representative Medical Expenditure Panel Survey for the years 2009, 2011, 2013, and 2015. Results . Overall, 25.8% had depression. In adjusted analyses, adults with RA and depression compared to those without depression were significantly more likely to have pain interference with normal work (severe pain: AOR = 2.22; 95% CI = 1.55, 3.18), functional limitations (AOR = 2.17; 95% CI = 1.61, 2.94), and lower mental health HRQoL scores. Adults with RA and depression had significantly higher annual healthcare expenditures ($14,752 versus 10,541, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mi>p</mml:mi><mml:mo>&lt;</mml:mo><mml:mo>.</mml:mo><mml:mn fontstyle="italic">001</mml:mn></mml:math>) and out-of-pocket spending burden. Adults with RA and depression were more likely to be unemployed and among employed adults, those with depression had a significantly higher number of missed work days annually and higher lost annual wages due to missed work days. Conclusions . This study highlights the importance of effectively managing depression in routine clinical practice of RA patients to reduce pain and functional limitations, improve quality of life, and lower direct and indirect healthcare costs.