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Epidemiology of Depression and Anxiety in Gout: A Systematic Review and Metaanalysis

Author

J Rheumatol. 2021 Jan 1;48(1):129-137. doi: 10.3899/jrheum.190974. Epub 2020 Mar 1.

Alyssa Howren 1, Drew Bowie 2, Hyon K Choi 3, Sharan K Rai 4, Mary A De Vera 5

Author Information

1 A. Howren, MSc, M.A. De Vera, PhD, University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, and Arthritis Research Canada, Richmond, and Collaboration for Outcomes Research and Evaluation, Vancouver, British Columbia, Canada.

2 D. Bowie, MD, University of British Columbia, Faculty of Medicine, Department of Medicine, Division of Internal Medicine, Vancouver, British Columbia, Canada.

3 H.K. Choi, MD, DrPH, Arthritis Research Canada, Richmond, British Columbia, Canada, and Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.

4 S.K. Rai, MSc, Arthritis Research Canada, Richmond, British Columbia, Canada, and Department of Nutrition and Program in Population Health Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.

5 A. Howren, MSc, M.A. De Vera, PhD, University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, and Arthritis Research Canada, Richmond, and Collaboration for Outcomes Research and Evaluation, Vancouver, British Columbia, Canada; mdevera@mail.ubc.ca.

Abstract

Objective: To conduct a systematic review of depression and anxiety among patients with gout that specifically evaluates the prevalence, incidence, determinants, and effects of these mental health comorbidities.

Methods: We conducted a literature search in Medline, Embase, Cochrane Database of Systematic Reviews, CINAHL, and PsycINFO using indexed terms and key words to identify studies reporting on depression/anxiety in patients with gout. This review included full-text articles published in English that reported on patients with gout, evaluated depression/anxiety using a routinely reported measure, and provided estimates or sufficient data on the prevalence, incidence, determinants, or effects of depression/anxiety. Metaanalyses were conducted using random effects models.

Results: Twenty of 901 articles identified through the search strategy met our inclusion criteria. All 20 studies evaluated depression, while only 10 assessed anxiety (50%). Metaanalyses suggest a positive association between mental health disorders and gout, as resultant pooled OR were 1.29 (95% CI 1.07-1.56) for depression and 1.29 (95% CI 0.96-1.73) for anxiety. Findings from four studies reporting on the incidence of depression in patients with gout resulted in a pooled HR of 1.17 (95% CI 1.01-1.36). Significant determinants of depression included number of tophi, frequency of flares, and oligo/polyarticular gout.

Conclusion: Our systematic review suggests that depression and anxiety are significantly associated with gout, highlighting the need for future research to focus on the onset of mental disorders after gout diagnosis. We also identify potential targets for intervention.