January 16, 2020
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Mental distress highly prevalent among adults with arthritis in Appalachia, southern US

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Kamil Barbour

Frequent mental distress is commonly reported among adults with arthritis across all 50 states and Washington, D.C., with the highest prevalence reported in the Appalachian region and southern states, according to data published in Morbidity and Mortality Weekly Report.

“Almost one in five of all adults, and one in three adults with arthritis, had frequent mental distress and depression, respectively,” Kamil Barbour, PhD, MPH, MS, of the CDC National Center for Chronic Disease Prevention and Health Promotion, told Healio Rheumatology. “These conditions were common in all states and the highest prevalence was clustered in the Appalachian and southern states.”

To estimate the prevalence of frequent mental distress and a history of depression in U.S. states among adults with arthritis, Price and colleagues studied data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS). According to the researchers, the BRFSS is an annual landline and cellular telephone survey conducted in all 50 states, territories and Washington, D.C. It collects data on health-related behavioral risk factors, health care access and chronic diseases among noninstitutionalized adults aged 18 years and older.

For their study, Price and colleagues evaluated data provided by 147,288 respondents who answered “yes” to the question, “Have you ever been told by a doctor or other health care professional that you have arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia?” Frequent mental distress was defined as a response of “14 days or more” to the question, “Now thinking about your mental health, which includes stress, depression and problems with emotions, for how many days during the past 30 days was your mental health not good?”

Frequent mental distress is commonly reported among adults with arthritis across all 50 states and Washington, D.C., with the highest prevalence reported in the Appalachian region and southern states, according to data.

Respondents were classified as having a history of depression if they answered affirmatively to the question, “Have you ever been told you have a depressive disorder (including depression, major depression, dysthymia, or minor depression)?” The researchers estimated the unadjusted, age-specific and age-adjusted prevalences of frequent mental distress and history of depression among the included respondents overall, as well as by state and by sociodemographic information.

According to the researchers, the median state age-adjusted prevalence of frequent mental distress and history of depression among adults with arthritis in all 50 states and Washington, D.C. was 16.8% and 32.1%, respectively. Prevalence rates for frequent mental distress ranged from 12.9% in Hawaii to 22.4% in Kentucky. For depression, prevalence rates ranged from 17.7% in Hawaii to 36.6% in Oklahoma. States with high prevalence rates of frequent mental distress were largely clustered in the Appalachian and southern states. However, there was no observed geographic clustering for depression.

In addition, age-adjusted prevalence rate for frequent mental distress was 19.9% among women compared with 14.6% among men, and 28% among people who were lesbian, gay or bisexual, compared with 16.8% among heterosexual respondents. The age-adjusted prevalence of a history of depression was 36.3% among women, compared with 24% among men, and 46.7% among those who were lesbian, gay or bisexual, compared with 30.5% among heterosexual adults. Rates also differed by race/ethnicity and education level.

“All adults with arthritis might benefit from systematic mental health screening by their health care team,” Barbour said. “If necessary, patients should be referred to mental health services with recommendations to participate in evidence-based interventions, such as physical activity and self-management education programs, whose proven benefits include reduced pain and improved mental health.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.