State-Specific Prevalence and Characteristics of Frequent Mental Distress and History of Depression Diagnosis Among Adults With Arthritis — United States, 2017

Janae D. Price, MPH; Kamil E. Barbour, PhD; Yong Liu, MD; Hua Lu, MS; Nancy L. Amerson; Louise B. Murphy, PhD; Charles G. Helmick, MD; Renee M. Calanan, PhD; Michelle Sandoval-Rosario, DrPH; Claudine M. Samanic, PhD; Kurt J. Greenlund, PhD; Craig W. Thomas, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2020;68(5152):1173-1178. 

In This Article

Abstract and Introduction

Introduction

An estimated 54.4 million (22.7%) U.S. adults have provider-diagnosed arthritis (arthritis), a number that is projected to rise to 78.4 million by 2040.[1,2] Chronic pain conditions like arthritis are associated with poorer mental health,[3] especially anxiety and depression, which can impede self-care and self-management behaviors.[1] Although the national prevalence of mental health conditions among adults with arthritis has been reported,[3,4] little is known about state-specific prevalences, particularly of frequent mental distress, a useful public health measure that reflects perceived mental health status. An estimated 11.3% and 19% of U.S. adults overall have frequent mental distress and a history of depression, respectively.[5] This analysis used 2017 Behavioral Risk Factor Surveillance System (BRFSS) data to estimate state-specific prevalence of frequent mental distress and history of depression among adults with arthritis. The median state age-adjusted prevalences of frequent mental distress and history of depression among adults with arthritis in the 50 states and the District of Columbia (DC) were 16.8% (range = 12.9% [Hawaii] to 22.4% [Kentucky]) and 32.1% (range = 17.7% [Hawaii] to 36.6% [Oklahoma]), respectively. Health care providers have an opportunity to improve the quality of life of arthritis patients by screening for mental health problems, encouraging physical activity, and making referrals to evidence-based programs such as physical activity programs,* self-management education programs (e.g., Chronic Disease Self-Management Program), psychotherapy,§ and cognitive behavioral therapy, that can help improve management of arthritis and mental health outcomes.

BRFSS is a landline and cellular telephone survey conducted annually in all 50 states, DC, and U.S. territories that collects information on health-related behavioral risk factors, health care access, and chronic conditions among noninstitutionalized U.S. adults aged ≥18 years. The median survey response rate for all states and DC in 2017 was 45.8% and ranged from 30.6% (Illinois) to 64.1% (Wyoming).** For this analysis, 2017 BRFSS data were restricted to those for 147,288 adults with arthritis, defined as a "yes" response to the question "Have you ever been told by a doctor or other health care professional that you have arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?" Frequent mental distress, a commonly used indicator of mental health, was defined as a response of ≥14 days to the question "Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?" The rationale for selecting the 14-day minimum period was based on evidence showing that clinicians and clinical researchers use a similar period as a marker for clinical depression and anxiety disorders, and a longer duration of reported symptoms is associated with a higher level of activity limitation.†† History of depression was defined as an affirmative response to the question "Have you ever been told you have a depressive disorder (including depression, major depression, dysthymia, or minor depression)?"

For adults with arthritis, the unadjusted, age-specific, and age-adjusted prevalences of frequent mental distress and history of depression were estimated overall, by state, and by sociodemographic characteristics. Estimates were age-adjusted using logistic regression modeling to produce predicted marginal probabilities. Differences in mental health outcomes across subgroups among adults with arthritis were tested using chi-squared tests; all differences reported were significant at α<0.05. All analyses were conducted using SAS software (version 9.4; SAS Institute) and SAS-callable SUDAAN (version 11.0.1; Research Triangle Institute) to account for the complex survey sampling design.

Overall, the nationwide unadjusted prevalence estimates of frequent mental distress and history of depression among adults with arthritis were 19.0% (95% confidence interval [CI] = 18.6–19.5) and 32.1% (95% CI = 31.5–32.6), respectively. Among adults with arthritis, the age-adjusted prevalence of frequent mental distress was significantly higher among women than among men (19.9% versus 14.6%) and persons who were lesbian/gay/bisexual compared with those who were heterosexual (28.0% versus 16.8%); it also varied by education level (Table 1). The age-adjusted prevalence of a history of depression was significantly higher among women (36.3%) than among men (24.0%), differed by race/ethnicity and education level, and was higher among lesbian/gay/bisexual adults (46.7%) than among heterosexual adults (30.5%).

Age-adjusted prevalence of both mental health measures among adults with arthritis varied widely by state (Table 2). The median state age-adjusted prevalence of frequent mental distress and history of depression among adults with arthritis in all 50 states and DC was 16.8% (range = 12.9% [Hawaii] to 22.4% [Kentucky]) and 32.1% (range = 17.7% [Hawaii] to 36.6% [Oklahoma]), respectively. States with high prevalences of frequent mental distress clustered in the Appalachian and southern states, whereas a similar geographic clustering was not observed for prevalence of a history of depression (Figure).

Figure.

Age-adjusted prevalence* of frequent mental distress and history of depression among adults aged ≥18 years with arthritis — Behavioral Risk Factor Surveillance System, 2017
Abbreviation: DC = District of Columbia.
*The percentage intervals for the quintile cutoffs vary because of variations in the distribution of frequent mental distress and history of depression.

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