Prevalence and determinants of psychiatric disorders in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is the most common chronic rheumatological disorder among southern Chinese patients in Hong Kong, with an estimated prevalence of 0.33%-0.35%. The resulting chronic pain, disability, social stress, and isolation contribute to the development of psychiatric symptoms.

The authors identify the prevalence and determining factors of psychiatric disorders in patients with RA.

Consecutive RA patients (N=200) were recruited from a rheumatology outpatient clinic. Psychiatric disorders were diagnosed by a psychiatrist using the Chinese-bilingual Structured Clinical Interview for DSM-IV Axis I disorders, Patient Research Version. Sociodemographic and clinical data and subjective health status and perceived social support data were also collected. Factors associated with the occurrence of psychiatric disorders were studied by multivariate analysis.

A total of 47 patients were diagnosed with a current psychiatric disorder (depressive disorders, 14.5%; anxiety disorders, 13.0%; schizophrenia, 0.5%). Major depressive disorder and generalized anxiety disorder were the commonest current mood and anxiety disorders, respectively. Independent predictors for a current psychiatric disorder were poverty and perceived poor social support. Limited social interaction, perceived poor social support, high pain intensity, and a family history of psychiatric disorders were independently associated with a current depressive disorder, whereas poverty and perceived poor social support were associated with a current anxiety disorder.

Depression and anxiety are common in Chinese patients with RA. Patients who lack social support or rely on economic assistance are more prone to the development of psychiatric disorders.