Research That Matters (January 17 - 20, 2008)

Background and Purpose: Depression among Arthritic individuals is associated with lower quality of life, increased risk of suicide, lower medical compliance and greater reliance on the health care system. Despite these problems, social workers and other health professionals do not consistently screen for depression among their clients with arthritis. The purpose of our study was to determine the extent of social work contact with depressed individuals with Arthritis or Rheumatism as well as to compare and contrast depressed and non-depressed individuals with Arthritis or Rheumatism in a large, national Canadian sample. Our hypothesis was that depression is correlated with a range of demographic (e.g. gender, age), physical health (e.g. ADL limitations, pain) and psychosocial characteristics (e.g. social support, self-esteem).

Methods: The nationally representative Canadian Community Health Survey 2000-2001 (CCHS) had a response rate of 84.7%, which resulted in a final sample of 130, 880 respondents. Our sample was comprised of 24,511 Canadians who reported they had been diagnosed with arthritis or rheumatism by a health professional. Respondents were diagnosed as depressed by using a subset of items from the Composite International Diagnostic Interview (CIDI). Chi-square tests, independent t-tests and logistic regression analyses were conducted with depression as the outcome.

Results: One in 10 Canadians with Arthritis or rheumatism has clinically relevant levels of depression. Depression rates were significantly higher among females, the unmarried, younger, and poorer individuals (p<.01). Individuals in pain, with limitations in ADLs or IADLs, with less social support and with alcohol dependency were vulnerable to depression (p<.01). Less than half of the depressed individuals had consulted a mental health professional and one-third were receiving anti-depressants. One in five depressed arthritic or rheumatic individuals had been suicidal in the past year. With respect to social work contact, two in every five individuals consulting a social worker were depressed. In fact, twenty-three percent of all depressed individuals with arthritis or rheumatism had seen a social worker in the past year and one-third of these depressed clients had seriously considered suicide in the past year. Only ten percent of those with depression had discussed mental health issues with a social worker.

Conclusions and Implications: The majority of depressed individuals with arthritis or rheumatism were not receiving adequate treatment for depression. Even depressed individuals seeing social workers were unlikely to discuss their mental health needs. Our findings suggest that all social work clients with arthritis or rheumatism should be screened for depression and suicidal ideation. Furthermore, this study's findings can help all health professionals to improve targeting and outreach efforts for identifying and treating the most vulnerable individuals with arthritis or rheumatism.