Modern Rheumatology

, Volume 23, Issue 2, pp 237–244 | Cite as

Major depressive disorder in patients with rheumatoid arthritis

  • Eri Sato
  • Katsuji Nishimura
  • Ayako Nakajima
  • Hiroshi Okamoto
  • Mikiko Shinozaki
  • Eisuke Inoue
  • Atsuo Taniguchi
  • Shigeki Momohara
  • Hisashi Yamanaka
Original Article



To investigate the point prevalence of major depressive disorder (MDD) as diagnosed by the Mini-International Neuropsychiatric Interview (M.I.N.I) in patients with rheumatoid arthritis (RA) and to determine whether MDD is related to features of RA disease, such as disease activity or physical dysfunction.


Of the patients with RA who participated in the IORRA survey conducted in October 2005, 162 were evaluated using the M.I.N.I., the Center for Epidemiologic Studies-Depression (CES-D) scale, and the two-question depression screen for MDD. RA clinical features were obtained from the concomitant IORRA cohort database. Relationships between MDD and RA disease features were analyzed by the Wilcoxon rank sum test and Pearson’s chi-square test.


The point prevalence of MDD as diagnosed by the M.I.N.I. was 6.8 % in our Japanese patients with RA. The percentage of depressive patients was determined to be 23.5, 17.3, or 7.4 % according to the CES-D scale with cut-off points of 16, 19, or 27, respectively, and 14.2 % according to the two-question depression screen. The best cut-off point for CES-D for risk of MDD diagnosed by M.I.N.I. in this study was determined to be 23, with 11.7 % depressive patients having the highest sum of sensitivity and specificity. No relationship between MDD and RA disease activity was detected.


By using the well-established structural interview instrument M.I.N.I., we determined the point prevalence of MDD in the RA patients enrolled in this study to be 6.8 %, leading to the conclusion that concomitant MDD does not seem to influence disease activity in RA patients.


Rheumatoid arthritis Major depressive disorder Mini-International Neuropsychiatric Interview Prevalence Center for Epidemiologic Studies-Depression Scale 


  1. 1.
    Pincus T, Griffith J, Pearce S, Isenberg D. Prevalence of self-reported depression in patients with rheumatoid arthritis. Br J Rheumatol. 1996;35:879–83.PubMedCrossRefGoogle Scholar
  2. 2.
    Dickens C, Jackson J, Tomenson B, Hay E, Creed F. Association of depression and rheumatoid arthritis. Psychosomatics. 2003;44:209–15.PubMedCrossRefGoogle Scholar
  3. 3.
    Frank RG, Beck NC, Parker JC, Kashani JH, Elliott TR, Haut AE, et al. Depression in rheumatoid arthritis. J Rheumatol. 1988;15:920–5.PubMedGoogle Scholar
  4. 4.
    Martens MP, Parker JC, Smarr KL, Hewett JE, Slaughter JR, Walker SE. Assessment of depression in rheumatoid arthritis: a modified version of the center for epidemiologic studies depression scale. Arthritis Rheum. 2003;49:549–55.PubMedCrossRefGoogle Scholar
  5. 5.
    Murphy S, Creed F, Jayson MI. Psychiatric disorder and illness behaviour in rheumatoid arthritis. Br J Rheumatol. 1988;27:357–63.PubMedCrossRefGoogle Scholar
  6. 6.
    Ohtsuki T, Inagaki M, Oikawa Y, Saitoh A, Kurosawa M, Muramatsu K, et al. Multiple barriers against successful care provision for depressed patients in general internal medicine in a Japanese rural hospital: a cross-sectional study. BMC Psychiatry. 2010;10:30.PubMedCrossRefGoogle Scholar
  7. 7.
    Ohayon MM, Schatzberg AF. Chronic pain and major depressive disorder in the general population. J Psychiatr Res. 2010;44:454–61.PubMedCrossRefGoogle Scholar
  8. 8.
    Williams JW Jr, Mulrow CD, Kroenke K, Dhanda R, Badgett RG, Omori D, et al. Case-finding for depression in primary care: a randomized trial. Am J Med. 1999;106:36–43.PubMedCrossRefGoogle Scholar
  9. 9.
    Peck JR, Smith TW, Ward JR, Milano R. Disability and depression in rheumatoid arthritis. A multi-trait, multi-method investigation. Arthritis Rheum. 1989;32:1100–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Kojima M, Kojima T, Suzuki S, Oguchi T, Oba M, Tsuchiya H, et al. Depression, inflammation, and pain in patients with rheumatoid arthritis. Arthritis Rheum. 2009;61:1018–24.PubMedCrossRefGoogle Scholar
  11. 11.
    Dowlati Y, Herrmann N, Swardfager W, Liu H, Sham L, Reim EK, et al. A meta-analysis of cytokines in major depression. Biol Psychiatry. 2010;67:446–57.PubMedCrossRefGoogle Scholar
  12. 12.
    Schiepers OJ, Wichers MC, Maes M. Cytokines and major depression. Prog Neuropsychopharmacol Biol Psychiatry. 2005;29:201–17.PubMedCrossRefGoogle Scholar
  13. 13.
    Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59 Suppl 20:22–33 (quiz 4–57).Google Scholar
  14. 14.
    Radloff L. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.CrossRefGoogle Scholar
  15. 15.
    Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med. 1997;12:439–45.PubMedCrossRefGoogle Scholar
  16. 16.
    Yamanaka H, Inoue E, Singh G, Tanaka E, Nakajima A, Taniguchi A, et al. Improvement of disease activity of rheumatoid arthritis patients from 2000 to 2006 in a large observational cohort study IORRA in Japan. Mod Rheumatol. 2007;17:283–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Yamada T, Nakajima A, Inoue E, Tanaka E, Hara M, Tomatsu T, et al. Increased risk of tuberculosis in patients with rheumatoid arthritis in Japan. Ann Rheum Dis. 2006;65:1661–3.PubMedCrossRefGoogle Scholar
  18. 18.
    Nakajima A, Inoue E, Tanaka E, Singh G, Sato E, Hoshi D, et al. Mortality and cause of death in Japanese patients with rheumatoid arthritis based on a large observational cohort. Scand J Rheumatol. 2010;39:360–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Nakajima A, Kamitsuji S, Saito A, Tanaka E, Nishimura K, Horikawa N, et al. Disability and patient’s appraisal of general health contribute to depressed mood in rheumatoid arthritis in a large clinical study in Japan. Mod Rheumatol. 2006;16:151–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Prevoo ML, van’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38:44–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Matsuda Y, Singh G, Yamanaka H, Tanaka E, Urano W, Taniguchi A, et al. Validation of a Japanese version of the Stanford Health Assessment Questionnaire in 3,763 patients with rheumatoid arthritis. Arthritis Rheum. 2003;49:784–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Turk DC, Okifuji A. Detecting depression in chronic pain patients: adequacy of self-reports. Behav Res Ther. 1994;32:9–16.PubMedCrossRefGoogle Scholar
  23. 23.
    Geisser ME, Roth RS, Robinson ME. Assessing depression among persons with chronic pain using the Center for Epidemiological Studies-Depression Scale and the Beck Depression Inventory: a comparative analysis. Clin J Pain. 1997;13:163–70.PubMedCrossRefGoogle Scholar
  24. 24.
    Ayuso-Mateos JL, Vazquez-Barquero JL, Dowrick C, Lehtinen V, Dalgard OS, Casey P, et al. Depressive disorders in Europe: prevalence figures from the ODIN study. Br J Psychiatry. 2001;179:308–16.PubMedCrossRefGoogle Scholar
  25. 25.
    Kawakami N, Takeshima T, Ono Y, Uda H, Hata Y, Nakane Y, et al. Twelve-month prevalence, severity, and treatment of common mental disorders in communities in Japan: preliminary finding from the World Mental Health Japan Survey 2002–2003. Psychiatry Clin Neurosci. 2005;59:441–52.PubMedCrossRefGoogle Scholar
  26. 26.
    Lok EY, Mok CC, Cheng CW, Cheung EF. Prevalence and determinants of psychiatric disorders in patients with rheumatoid arthritis. Psychosomatics. 2010;51:338-e8.Google Scholar
  27. 27.
    Zautra AJ, Yocum DC, Villanueva I, Smith B, Davis MC, Attrep J, et al. Immune activation and depression in women with rheumatoid arthritis. J Rheumatol. 2004;31:457–63.PubMedGoogle Scholar
  28. 28.
    El-Tantawy AM, El-Sayed AE, Kora BA, Amin RT. Psychiatric morbidity associated with some cytokines (IL-1beta, IL-12, IL-18 and TNF-alpha) among rheumatoid arthritis patients. Egypt J Immunol. 2008;15:1–11.PubMedGoogle Scholar

Copyright information

© Japan College of Rheumatology 2012

Authors and Affiliations

  • Eri Sato
    • 1
  • Katsuji Nishimura
    • 2
  • Ayako Nakajima
    • 1
  • Hiroshi Okamoto
    • 1
  • Mikiko Shinozaki
    • 1
  • Eisuke Inoue
    • 1
  • Atsuo Taniguchi
    • 1
  • Shigeki Momohara
    • 1
  • Hisashi Yamanaka
    • 1
  1. 1.Institute of RheumatologyTokyo Women’s Medical UniversityShinjuku-ku, TokyoJapan
  2. 2.Department of PsychiatryTokyo Women’s Medical UniversityTokyoJapan

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