Depression and Anxiety in Patients After Gout Diagnosis

Gout, an inflammatory form of arthritis, has been reported to be undertreated due to its difficulty to diagnose. Consequently, many people who are suffering from unpredictable gout flare-ups are negatively impacted both physically and psychologically. The current literature on the psychological impact of gout is inconsistent. Prior studies have estimated the prevalence of depression and anxiety in gout patients ranges from as low as 1.9% to upwards of 40% for depression and from 3.8% to 10%for anxiety. BMC Rheumatology published a population-based study investigating the incidence of depression and anxiety in patients after being diagnosed with gout.

Using individual-level, de-identified health services data for the entire population of British Columbia (estimated ~5 million people), all outpatient visits, inpatient visits, deaths, and demographics from 1985-2018 were collected. A cohort of 157 426 patients aged ≥18 years of age with gout were matched 1:1 with a cohort of controls without gout based on age and sex. Several covariates were also assessed and included: age, sex, average neighborhood income, urban versus rural residence, and comorbidities.

The authors reported a modest association between gout and incident anxiety and depression. Prior to gout diagnosis, the prevalence of depression and anxiety was 24.3% and 5.2%, respectively, and females were significantly more likely to be diagnosed with depression or anxiety before gout diagnosis. Over a 6-year period, 19 896 cases of depression were reported overall. The incidence rate of depression for individuals with gout was 12.9 per 1000 person-years compared with 11.1 per 1000 person-years in the control cohort. The median time to a depression diagnosis in patients with gout was 3.9 years. Regarding incident anxiety, there were 10 483 cases overall. The median time to incident anxiety following a gout diagnosis was 4.6 years. Comparing gout patients with the control cohort, the rate of anxiety diagnosis was 5.4 per 1000 person-years and 4.6 per 1000 person-years, respectively.

“Our study’s use of a population-based cohort capturing outpatient and inpatient visits for nearly 30 years and the application of validated case definitions for depression and anxiety strengthens our understanding of the incidence of these mental health disorders in individuals with gout,” the authors said. The authors also cited previous qualitative research that highlights experiences of isolation, depression, and anxiety related to the unpredictability of gout flares, “While incident depression and anxiety are increased among patients with gout compared with controls… increases among persons with gout reported in our study may reflect the episodic nature of this chronic disease,” they added.