VANCOUVER, British Columbia—Rheumatoid arthritis (RA) pain and disability have a well-established connection to reactive depression in the RA patient, and clinically depressed patients often have decreased health and functioning, whether they have RA or not. Now a new aspect of the mind-body connection has emerged in work by Canadian researchers which shows that depression in the spouse of an RA patient can affect that patient's well-being.

A new study in Arthritis Care & Research suggests that spousal depression may increase an RA patient’s level of disability and disease activity across time.¹

“Caring for a spouse with RA may be a difficult and challenging task. Clinicians might consider consulting with the spouse to address any possible issues, such as depression, that may impact their care-giving capabilities” Mark Lam, MA, told MSK report.

Mr. Lam, who is Canada Graduate Scholar in the Health Psychology Program at the University of British Columbia, and colleagues found a significant relationship between RA patients’ levels of disease activity (pain, swelling, tenderness, stiffness, and fatigue) and physical limitations (pain, weakness, tingling, and stiffness), and their spouses’ levels of depressive symptoms. Higher levels of spousal depression predicted a worse disease course for RA patients over a 1-year period.

Unique study focused on spouses, not on RA patients’ perceptions of spouses

Prior studies investigating the role of the spouse in the disease course of RA patients have relied on the patients’ reports of their spouses’ mood and behavior. Lam and his colleagues pursued a more direct route, and used a mood questionnaire with the spouses themselves.

The researchers conducted two interviews with 133 married RA patients. These patients responded to the Rheumatoid Arthritis Disease Activity Index (RADAI) and the Disabilities of Arm, Shoulder and Hand (DASH) measure during the initial interview and at a follow-up session one year later. Both the RA patients and their spouses completed The Center for Epidemiologic Studies Depression Scale (CES-D) at the initial and follow-up interviews.

The RA patients’ levels of disease activity and depressive symptoms decreased over the course of the one-year study. Similarly, spouses’ levels of depressive symptoms decreased from the initial assessment to the follow-up. Despite these decreases, the spouses’ initial CES-D scores were predictive of RA patients’ RADAI and DASH scores at follow-up. This relationship, between spouses’ initial levels of depression and RA patients’ levels of disease activity and impairment, remained significant even after controlling for RA patient characteristics such as initial levels of depression, disability, disease activity, age, number of years married, education, disease duration, and employment status.

Depressed spouses may provide less support to RA patients

The study authors suggested that support may be a key path through which spouse depression can influence RA patients’ well-being. Depressed spouses are less likely to provide satisfactory levels of support and assistance to patients. In turn, RA patients who do not receive support from their spouses are less likely to use adaptive coping strategies to deal with their fluctuating levels of pain and disability.

Translating research into practice: talk to the spouse, treat the couple

A spouse is likely to play a pivotal role in helping RA patients deal with pain, stiffness, and fatigue. Unfortunately, a spouse with depressive symptoms may worsen the disease course of an RA patient. The researchers suggest that clinicians initiate a discussion with RA patients and their spouses about the realities and potential problems of everyday life, such as decreased mood or depression, of dealing with the daily stressors associated with chronic illnesses.

This study points to the importance of “looking beyond the individual as the treatment unit…and seeing the dyad as the treatment unit instead,” the authors wrote.

Reference

1. Lam A, Lehman AJ, Puterman E, DeLongis A. Spouse depression and disease course among persons with rheumatoid arthritis. Arthritis & Rheumatism (Arthritis Care & Research). 2009;61(8):1011-1017.