The Relationship Between Disease Symptoms, Life Events, Coping and Treatment, and Depression Among Older Adults with Osteoarthritis

JOANNA E.M. SALE, MONIQUE GIGNAC, and GILLIAN HAWKER

ABSTRACT.

Objective. The intent of this cross-sectional study was to broaden the range of variables examined in relationship to depression in osteoarthritis (OA) to include comorbidity, stressful life events, and the ways people respond to their disease. We examined the relationship of coping behaviors and perceptions, and medical treatments received for OA and depressive symptoms.

Methods. In the fifth year of a prospective cohort study, 1227 individuals ≥ 62 years of age with hip/knee OA provided information about sociodemographics (age, sex, living circumstances, education), arthritis severity (WOMAC pain and function; ClinHAQ fatigue), comorbidity, life events, coping behavior, coping efficacy, treatment (pain management, treatment for depression), and depressed mood (Centre for Epidemiological Studies Depression scale, CES-D). Using hierarchical linear regression, variables were entered in blocks to predict CES-D scores. In the final block, the interaction of coping behavior and coping efficacy was tested.

Results. The response rate was 82.4% (n = 1227/1489). The mean CES-D score was 9.4, with 21.3% of individuals scoring ≥ 16 (supporting depressed mood). Higher level of depressed mood was independently and significantly associated with being female, experiencing greater pain and fatigue, experiencing stressful life events, more coping behaviors, receiving treatment for depression/mental illness, and a coping behavior by coping efficacy interaction, with 63.4% of the variance accounted for in the model.

Conclusion. Among older adults with OA, the prevalence of depressive symptoms is high. Longitudinal studies must consider OA management strategies, including both the amount of behavioral coping and its perceived efficacy, to elucidate potential interventions designed to reduce depression in patients with OA. (First Release Jan 15 2008; J Rheumatol 2008;35:335-42)

Key Indexing Terms:

OSTEOARTHRITIS
DEPRESSION
COPING
MEDICAL TREATMENT

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From the Department of Medicine, Division of Rheumatology, Women's College Hospital (formerly Sunnybrook and Women's College Health Sciences Centre); Mobility Program Clinical Research Unit, St. Michael's Hospital; Division of Outcomes and Population Health, The University Health Network and Department of Public Health Sciences, The University of Toronto; and the Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

Supported by the Canadian Arthritis Network and the Canadian Institutes of Health Research (CIHR; post-doctoral award to Dr. Sale, CIHR Grant MT-15468), and the Orthopaedic and Arthritic Institute. Dr. Hawker received support as a CIHR scientist and as the F.M. Hill Chair in Academic Women's Medicine.

J.E.M. Sale, PhD, Department of Medicine, Division of Rheumatology, Women's College Hospital, Mobility Program Clinical Research Unit, St. Michael's Hospital; M. Gignac, PhD, Associate Professor, University of Toronto, Division of Outcomes and Population Health, The University Health Network; G. Hawker, MD, MSc, Professor, University of Toronto.

Address reprint requests to J.E.M. Sale, Mobility Program Clinical Research Unit, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada. E-mail: jsale@interlog.com

Accepted for publication October 4, 2007.

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