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Stories for Reprint
Rheumatoid Arthritis: Depression's Lingering Effects
By Petya Eckler, MARRTC Staff
Even after a depressive episode is passed, depression continues to influence people with chronic disease, a new study finds. The emotions of people with rheumatoid arthritis (RA) and a history of depression are more affected by the pain than the emotions of those who have never been depressed, says a study yet to be published in the scientific journal Pain.
Those with RA and a history of major depression were twice more likely to vent their emotions and have mood changes than those who had never been depressed. If they were distressed during the study period, participants with a history of depression also felt less control over the pain than those who had never been depressed.
The study included 188 participants with RA, 73 of whom had previous depressive episodes. None had current depression. For 30 consecutive days, participants completed a diary, where they described their arthritis pain for the day, how they coped with it, and their mood. The study was conducted by psychologists and a sociologist from University of Connecticut Health Center in Farmington, Conn., Arizona State University in Tempe, Ariz., and Pace University in New York City.
Previous research has shown that depression is related to more pain and poorer coping in people with chronic illness. But the uniqueness of this study is that it shows the consequences of a major depressive episode that has long since resolved.
Past depression affects how a person is able to cope with pain, said Dr. Alex Zautra, a psychologist at Arizona State University and one of the authors.
Past depression may create an emotional vulnerability which had been hidden until the onset of RA, researchers concluded.
Maintaining emotional stability is especially important when managing chronic physical pain, the authors said.
"Pain is an emotional experience," Zautra said, and adding pain to the other challenges of chronic illness strains further people's emotional capacity.
But while the benefits of emotional stability are clear, many people with chronic rheumatic diseases are still reluctant to address their mental health, which is apparent from another study.
Researchers in Argentina conducted a standardized mental health test on people with rheumatic diseases who had never been treated with antidepressants. Of the 98 people who got tested, three quarters scored positive, which meant that they had some mental disturbance. But of those who scored positive, only half agreed to consult a psychiatrist for further evaluation and of those who did see a psychiatrist and got a final diagnosis, only a third accepted treatment.
Zautra said part of this resistance to treatment may be due to cultural differences but even among the participants in Zautra's study, who were all American, only a quarter had gotten treatment for their past depressive episodes.
Denial is one common problem for people with mental problems but Zautra says a physician's bedside manner can make a difference.
"A physician who's properly trained can get through to the patient with the right bedside manner," he said, but added that the problem with physicians is that they usually don't have enough time and training to address psychiatric issues.
How the patient is approached by the physician can make a difference because in the long term the patient gets better quicker, he said.
Another way to make psychiatric help more acceptable is to show its various aspects, Zautra said.
"Our consumers are increasingly aware of the fact that there's more than one way to treat depression. Psychiatric means is just one way," Zautra said. "Exercise, social means, family support are other ways."
For Zautra the deeper message of his study is that chronic illness should be addressed in a broader sense where psychical and emotional health go hand in hand.
"Wellbeing can be affected both by the physical and by the emotional health and we need to take their whole selves in mind in trying to figure out how to help them [patients]."
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