Dataset Information

Dynamic Effects of Depressive Symptoms on Osteoarthritis Knee Pain.

ABSTRACT:

Objective

To estimate the dynamic causal effects of depressive symptoms on osteoarthritis (OA) knee pain.

Methods

Marginal structural models were used to examine dynamic associations between depressive symptoms and pain over 48 months among older adults (n = 2,287) with radiographic knee OA (Kellgren/Lawrence grade 2 or 3) in the Osteoarthritis Initiative. Depressive symptoms at each annual visit were assessed (threshold ?16) using the Center for Epidemiologic Studies Depression Scale. OA knee pain was measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale, rescaled to range from 0 to 100.

Results

Depressive symptoms at each visit were generally not associated with greater OA knee pain at subsequent time points. Causal mean differences in WOMAC pain score comparing depressed to nondepressed patients ranged from 1.78 (95% confidence interval [95% CI] -0.73, 4.30) to 2.58 (95% CI 0.23, 4.93) within the first and fourth years, and the depressive symptoms by time interaction were not statistically significant (P = 0.94). However, there was a statistically significant dose-response relationship between the persistence of depressive symptoms and OA knee pain severity (P = 0.002). Causal mean differences in WOMAC pain score comparing depressed to nondepressed patients were 0.89 (95% CI -0.17, 1.96) for 1 visit with depressive symptoms, 2.35 (95% CI 0.64, 4.06) for 2 visits with depressive symptoms, and 3.57 (95% CI 0.43, 6.71) for 3 visits with depressive symptoms.

Conclusion

The causal effect of depressive symptoms on OA knee pain does not change over time, but pain severity significantly increases with the persistence of depressed mood.

SUBMITTER: Rathbun AM

PROVIDER: S-EPMC5607075 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Dynamic Effects of Depressive Symptoms on Osteoarthritis Knee Pain.

Rathbun Alan M AM Stuart Elizabeth A EA Shardell Michelle M Yau Michelle S MS Baumgarten Mona M Hochberg Marc C MC

Arthritis care & research 20171206 1

<h4>Objective</h4>To estimate the dynamic causal effects of depressive symptoms on osteoarthritis (OA) knee pain.<h4>Methods</h4>Marginal structural models were used to examine dynamic associations between depressive symptoms and pain over 48 months among older adults (n = 2,287) with radiographic knee OA (Kellgren/Lawrence grade 2 or 3) in the Osteoarthritis Initiative. Depressive symptoms at each annual visit were assessed (threshold ≥16) using the Center for Epidemiologic Studies Depression S ...[more]

PMID: 28320048

Similar Datasets

Project description:ObjectiveDuloxetine is a treatment approved by the US Food and Drug Administration for both osteoarthritis (OA) pain and depression, though uptake of duloxetine in knee OA management varies. We examined the cost-effectiveness of adding duloxetine to knee OA care in the absence or presence of depression screening.MethodsWe used the Osteoarthritis Policy Model, a validated computer microsimulation of knee OA, to examine the value of duloxetine for patients with knee OA who have moderate pain by comparing 3 strategies: 1) usual care, 2) usual care plus duloxetine for patients who screen positive for depression on the Patient Health Questionnaire 9 (PHQ-9), and 3) usual care plus universal duloxetine. Outcome measures included quality-adjusted life years (QALYs), lifetime direct medical costs, and incremental cost-effectiveness ratios (ICERs), discounted at 3% annually. Model inputs, drawn from the published literature and national databases, included annual cost of duloxetine ($721-937); average pain reduction for duloxetine (17.5 points on the Western Ontario and McMaster Universities Osteoarthritis Index pain scale [0-100]), and likelihood of depression remission with duloxetine (27.4%). We considered 2 willingness-to-pay (WTP) thresholds of $50,000/QALY and $100,000/QALY. We varied parameters related to the PHQ-9 and the cost of duloxetine, efficacy, and toxicities to address uncertainty in model inputs.ResultsThe screening strategy led to an additional 17 QALYs per 1,000 subjects and increased costs by $289/subject (ICER = $17,000/QALY). Universal duloxetine led to an additional 31 QALYs per 1,000 subjects and $1,205 per subject (ICER = $39,300/QALY). Under the majority of sensitivity analyses, universal duloxetine was cost-effective at the $100,000/QALY threshold.ConclusionThe addition of duloxetine to usual care for knee OA patients with moderate pain, regardless of depressive symptoms, is cost-effective at frequently used WTP thresholds.

Project description:BackgroundDepression has been shown in some studies to be associated with knee pain. Females were widely recognized as more vulnerable to depression and knee pain than males. However, the role of sex in this correlation was under-researched. This study aimed to investigate the association between depressive symptoms and subsequent knee pain, as well as whether and how sex would moderate this association based on a four-wave (Wave 1 in 2010-2011, Wave 2 in 2013, Wave 3 in 2015, and Wave 4 in 2018) longitudinal study among middle-aged and elderly Chinese adults.MethodsSeventeen thousand seven hundred eight participants were recruited and followed in the China Health and Retirement Longitudinal Study (CHARLS). Ten thousand four hundred fifty-one entered the final analysis based on the inclusion and exclusion criteria. Knee pain was assessed by self-report. Depressive symptoms were evaluated using the validated 10-item Center for Epidemiological Studies-Depression Scale (CESD-10). Cox proportional hazards models were used to calculate hazard ratios with 95% confidence intervals (CIs) after controlling potential confounders to examine the association between depressive symptoms and subsequent incident and persistent knee pain. Non-linear association of depressive symptoms score (CESD-10) and risk of knee pain was also investigated via applying 3-knotted restricted cubic spline regression. An interaction term of depressive symptoms status and sex was added to investigate the moderating effect of sex on the relationship between depressive symptoms status and the risk of knee pain.ResultsThe median follow-up time was seven years for all the outcomes. Participants with depressive symptoms were 1.45 times (95% CI: 1.34-1.56) and 2.16 times (95% CI: 1.85-2.52) more likely to develop the incident and persistent knee pain after multivariable were adjusted, compared with those without depressive symptoms. There was a non-linear association between CESD-10 score and risk of knee pain. Compared with females, males had an enhanced correlation between depressive symptoms status and knee pain (multivariable-adjusted HR: 1.22, 95% CI: 1.05-1.42 and HR: 1.57, 95% CI: 1.14-2.17 for the incident and persistent knee pain, respectively).ConclusionDepressive symptoms are independently associated with an excess risk of knee pain, with a stronger correlation for males than females among middle-aged and elderly Chinese adults.

Dataset Information

Dynamic Effects of Depressive Symptoms on Osteoarthritis Knee Pain.

Objective

Methods

Results

Conclusion

Publications

Dynamic Effects of Depressive Symptoms on Osteoarthritis Knee Pain.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets