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Researchers report that 32 percent of people with arthritis have a history of depression. Getty Images
  • Researchers say 19 percent of adults with arthritis report having frequent mental distress and 32 percent have a history of depression.
  • They say the percentages are higher in states such as Kentucky, Oklahoma, and Arkansas.
  • Experts say the pain associated with arthritis can lead to mental health issues.

Researchers say they have found a link between arthritis and depression.

In fact, the researchers say, an estimated 19 percent of adults with arthritis experience “frequent mental distress” and 32 percent have a history of depression.

That compares with about 8 percent of the overall population that report having depression.

The analysis by the Centers for Disease Control and Prevention (CDC) used the 2017 Behavioral Risk Factor Surveillance System to “estimate state-specific prevalence of frequent mental distress and history of depression among adults with arthritis.”

CDC officials report that 22 percent of adults in the United States have arthritis that has been diagnosed.

The study included 147,288 adults in the United States, in all 50 states and the District of Columbia.

“People with autoimmune conditions suffer from depression,” Dr. Anca D. Askanase, the director of the Columbia University Lupus Center in New York and an associate professor of medicine, told Healthline. “Whether this depression is reactive to the stressors of the chronic condition or a separate issue possibly related to our autoimmunity is not fully understood.”

“The incidence of mood disorders in people with autoimmune conditions seem to vary in different studies and different disease states, and the quotes are somewhere between 15 and 40 percent, depending on the source and the condition,” Askanase said. “One can infer that early diagnosis and treatment of the autoimmune disease and the associated depression may result in better outcomes. However, these are inferences and need to be proven [in] prospective cohort and clinical trial settings.”

Many factors appeared to affect the results of the CDC study.

Geography played a part, with people in Kentucky reporting the highest frequency of mental distress (22 percent). They were followed by people in North Carolina and New Mexico.

The lowest rates were reported in Hawaii, Minnesota, and North Dakota (all about 13 percent).

People in Oklahoma (36 percent) reported the highest frequency of depression, followed by Kentucky and Arkansas.

The lowest rates of depression among those suffering from arthritis were reported in Hawaii (17 percent) and the District of Columbia.

Women and people who identified as LGBT experienced higher rates of frequent mental distress and depression than men and heterosexuals.

Rates also varied depending on education level.

Another factor is people with chronic conditions who do not follow treatment recommendations.

The study researchers said those reporting having depression were three times more likely to not follow doctor’s recommendations concerning medication, exercising, diet, and follow-up appointments.

The researchers said adults with arthritis could benefit from mental health screenings and referrals, as well as physical activity and self-management education programs.

“The brain is the host, per se, for chronic pain and perceives it as a threat, and initially will put the person on a high state of alert, causing hypervigilance and even anxiety,” Jackie Kilraine, a doctor of chiropractic and the founder of Expressing Optima, a website for women with chronic health issues, told Healthline. “This takes a lot of energy to maintain and, generally, a person will develop depression as it is a lower brainwave state and takes less physical energy to maintain, as the body only has so much.”

“People with chronic pain, which can come from arthritis, develop what researchers have named a pain personality,” Kilraine added. “They are more fearful, pessimistic, have low motivation, have difficulty defining and setting meaningful goals, and require high levels of self-assurance.”

Latagia Copeland-Tyronce, MSW, CADAS, a 33-year-old Detroit-based writer and activist, has had severe arthritis for decades after injuring her hip in a car accident when she was 12.

She said she understands the relationship between arthritis pain and depression.

“This caused me to begin to really suffer from depression and increasing anxiety, both of which I chose to deal with on my own without mental health treatments,” Copeland-Tyronce told Healthline. “I’m not at all surprised about the study’s conclusions. I experience it myself and have seen the same in several people that I know, including my husband, who also suffers from arthritis and depression.”

Dr. Elizabeth Landsverk, the founder of ElderConsult Geriatric Medicine and a consultant to the National Institute on Aging, said it was “striking” to her that researchers are emphasizing the depression part of the equation without more emphasis on pain.

“In my experience as a clinician, and demonstrated by studies, pain increases risk of depression,” she said. “There was no comment on the need to more adequately treat the pain of arthritis, nor to look at the root causes.”

“Treat the pain,” Landsverk added. “There is good evidence and I have seen this many times with elders with dementia who are very agitated, and the cause is seen to be their dementia, and treated with anxiety meds. Many elders who may be irritable from pain become less aggressive with their pain relieved. The history of pain or arthritis is important.”

Landsverk said one can also look at the geography of the study to determine those causes, with the higher rates coming in lower-income populations where there isn’t as much access to affordable healthcare.

“There is really no way around a more comprehensive plan to treat chronic disease in parts of America that have been deindustrialized,” she said. “Band-Aid programs will not get to the root of the issue. Deaths and chronic disease come from a community that is struggling. What would help is more investment in infrastructure.”