Association between inflammatory joint disease and severe or treatment-resistant depression: population-based cohort and case-control studies in Sweden

Philip Brenner; Johan Askling; David Hägg; Lena Brandt; Paul Stang; Johan Reutfors

doi:10.1016/j.genhosppsych.2024.04.007

Association between inflammatory joint disease and severe or treatment-resistant depression: population-based cohort and case-control studies in Sweden

Gen Hosp Psychiatry. 2024 Apr 27:89:23-31. doi: 10.1016/j.genhosppsych.2024.04.007. Online ahead of print.

Authors

Philip Brenner¹, Johan Askling², David Hägg³, Lena Brandt⁴, Paul Stang⁵, Johan Reutfors⁶

Affiliations

¹ Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra stationsgatan 69, 113 64 Stockholm, Sweden. Electronic address: philip.brenner@ki.se.
² Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden. Electronic address: johan.askling@ki.se.
³ Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden. Electronic address: david.hagg@ki.se.
⁴ Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden. Electronic address: lena.brandt@ki.se.
⁵ Janssen Research and Development, Titusville, NJ, 08560,USA.
⁶ Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden. Electronic address: johan.reutfors@ki.se.

PMID: 38714100
DOI: 10.1016/j.genhosppsych.2024.04.007

Abstract

Objective: To investigate whether the association between depression and inflammatory joint disease (IJD; rheumatoid arthritis [RA], psoriatic arthritis [PsA], ankylosing spondylitis/spondyloarthropathies [AS], and juvenile idiopathic arthritis [JIA]) is affected by the severity or treatment-resistance of depression.

Method: Parallel cohort studies and case-control studies among 600,404 patients with a depressive episode identified in Swedish nationwide administrative registers. Prospective and retrospective risk for IJD in patients with depression was compared to matched population comparators, and the same associations were investigated in severe or treatment-resistant depression. Analyses were adjusted for comorbidities and sociodemographic covariates.

Results: Patients with depression had an increased risk for later IJD compared to population comparators (adjusted hazard ratio (aHR) for any IJD 1.34 [95% CI 1.30-1.39]; for RA 1.27 [1.15-1.41]; PsA 1.45 [1.29-1.63]; AS 1.32 [1.15-1.52]). In case-control studies, patients with depression more frequently had a history of IJD compared to population controls (adjusted odds ratio (aOR) for any IJD 1.43 [1.37-1.50]; RA 1.39 [1.29-1.49]; PsA 1.59 [1.46-1.73]; AS 1.49 [1.36-1.64]; JIA 1.52 [1.35-1.71]). These associations were not significantly different for severe depression or TRD.

Conclusion: IJD and depression are bidirectionally associated, but this association does not seem to be influenced by the severity or treatment resistance of depression.

Keywords: Antidepressants; Depression; Epidemiology; Rheumatic diseases; Rheumatoid arthritis; Severe depression; Treatment-resistant.