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Research ArticleAccepted Article

Epidemiology of depression and anxiety in gout: A systematic review and metaanalysis

Alyssa Howren, Drew Bowie, Hyon K. Choi, Sharan K. Rai and Mary A. De Vera
The Journal of Rheumatology March 2020, jrheum.190974; DOI: https://doi.org/10.3899/jrheum.190974
Alyssa Howren
From the University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada; Arthritis Research Canada, Richmond, BC, Canada; Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada; University of British Columbia, Faculty of Medicine, Department of Medicine, Division of Internal Medicine, Vancouver, BC, Canada; Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Nutrition and Program in Population Health Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA. This research was supported by a Strategic Operating Grant from The Arthritis Society (#SOG-18-0192). Dr. De Vera holds a Canada Research Chair in Medication Adherence, Utilization, and Outcomes and is The Arthritis Society. Ms. Howren is a recipient of a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship – Doctoral Award and a Wayne Riggs Interdisciplinary Doctoral Scholarship in Pharmaceutical Sciences (University of British Columbia). Ms. Rai is supported by a Doctoral Foreign Study Award from the Canadian Institutes of Health Research. Address correspondence to Mary A. De Vera, PhD University of British Columbia Faculty of Pharmaceutical Sciences 2405 Wesbrook Mall Vancouver, BC, V6T 1Z3 Email: mdevera@mail.ubc.ca
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Drew Bowie
From the University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada; Arthritis Research Canada, Richmond, BC, Canada; Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada; University of British Columbia, Faculty of Medicine, Department of Medicine, Division of Internal Medicine, Vancouver, BC, Canada; Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Nutrition and Program in Population Health Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA. This research was supported by a Strategic Operating Grant from The Arthritis Society (#SOG-18-0192). Dr. De Vera holds a Canada Research Chair in Medication Adherence, Utilization, and Outcomes and is The Arthritis Society. Ms. Howren is a recipient of a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship – Doctoral Award and a Wayne Riggs Interdisciplinary Doctoral Scholarship in Pharmaceutical Sciences (University of British Columbia). Ms. Rai is supported by a Doctoral Foreign Study Award from the Canadian Institutes of Health Research. Address correspondence to Mary A. De Vera, PhD University of British Columbia Faculty of Pharmaceutical Sciences 2405 Wesbrook Mall Vancouver, BC, V6T 1Z3 Email: mdevera@mail.ubc.ca
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Hyon K. Choi
From the University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada; Arthritis Research Canada, Richmond, BC, Canada; Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada; University of British Columbia, Faculty of Medicine, Department of Medicine, Division of Internal Medicine, Vancouver, BC, Canada; Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Nutrition and Program in Population Health Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA. This research was supported by a Strategic Operating Grant from The Arthritis Society (#SOG-18-0192). Dr. De Vera holds a Canada Research Chair in Medication Adherence, Utilization, and Outcomes and is The Arthritis Society. Ms. Howren is a recipient of a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship – Doctoral Award and a Wayne Riggs Interdisciplinary Doctoral Scholarship in Pharmaceutical Sciences (University of British Columbia). Ms. Rai is supported by a Doctoral Foreign Study Award from the Canadian Institutes of Health Research. Address correspondence to Mary A. De Vera, PhD University of British Columbia Faculty of Pharmaceutical Sciences 2405 Wesbrook Mall Vancouver, BC, V6T 1Z3 Email: mdevera@mail.ubc.ca
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Sharan K. Rai
From the University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada; Arthritis Research Canada, Richmond, BC, Canada; Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada; University of British Columbia, Faculty of Medicine, Department of Medicine, Division of Internal Medicine, Vancouver, BC, Canada; Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Nutrition and Program in Population Health Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA. This research was supported by a Strategic Operating Grant from The Arthritis Society (#SOG-18-0192). Dr. De Vera holds a Canada Research Chair in Medication Adherence, Utilization, and Outcomes and is The Arthritis Society. Ms. Howren is a recipient of a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship – Doctoral Award and a Wayne Riggs Interdisciplinary Doctoral Scholarship in Pharmaceutical Sciences (University of British Columbia). Ms. Rai is supported by a Doctoral Foreign Study Award from the Canadian Institutes of Health Research. Address correspondence to Mary A. De Vera, PhD University of British Columbia Faculty of Pharmaceutical Sciences 2405 Wesbrook Mall Vancouver, BC, V6T 1Z3 Email: mdevera@mail.ubc.ca
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Mary A. De Vera
From the University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada; Arthritis Research Canada, Richmond, BC, Canada; Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada; University of British Columbia, Faculty of Medicine, Department of Medicine, Division of Internal Medicine, Vancouver, BC, Canada; Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Nutrition and Program in Population Health Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA. This research was supported by a Strategic Operating Grant from The Arthritis Society (#SOG-18-0192). Dr. De Vera holds a Canada Research Chair in Medication Adherence, Utilization, and Outcomes and is The Arthritis Society. Ms. Howren is a recipient of a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship – Doctoral Award and a Wayne Riggs Interdisciplinary Doctoral Scholarship in Pharmaceutical Sciences (University of British Columbia). Ms. Rai is supported by a Doctoral Foreign Study Award from the Canadian Institutes of Health Research. Address correspondence to Mary A. De Vera, PhD University of British Columbia Faculty of Pharmaceutical Sciences 2405 Wesbrook Mall Vancouver, BC, V6T 1Z3 Email: mdevera@mail.ubc.ca
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Abstract

Objective To conduct a systematic review of depression and anxiety among patients with gout that specifically evaluates the prevalence, incidence, determinants, and impacts of these mental health comorbidities.

Methods We conducted a literature search in Medline, Embase, Cochrane Database of Systematic Reviews, CINAHL, and PsycINFO using indexed terms and key words to identify studies reporting on depression/anxiety in patients with gout. This review included full-text articles published in English that reported on patients with gout, evaluated depression/anxiety using a routinely reported measure, and provided estimates or sufficient data on the prevalence, incidence, determinants, or impacts of depression/anxiety. Meta-analyses were conducted using random effects models.

Results 20 of 901 articles identified through the search strategy met our inclusion criteria. All 20 studies evaluated depression, while only ten assessed anxiety (50.0%). Meta-analyses suggest a positive association between mental health disorders and gout, as resultant pooled odds ratios were 1.29 (95% confidence interval [CI] 1.07 to 1.56) for depression and 1.29 (95% CI 0.96 to 1.73) for anxiety. Findings from four studies reporting on the incidence of depression in patients with gout resulted in a pooled hazard ratio of 1.17 (95% CI 1.01 to 1.36). Significant determinants of depression included number of tophi, frequency of flares, and oligo/polyarticular gout.

Conclusion Our systematic review suggests depression and anxiety are significantly associated with gout and highlights the need for future research to focus on the onset of mental disorders after gout diagnosis as well as identify potential targets for intervention.

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Accepted manuscript
Epidemiology of depression and anxiety in gout: A systematic review and metaanalysis
Alyssa Howren, Drew Bowie, Hyon K. Choi, Sharan K. Rai, Mary A. De Vera
The Journal of Rheumatology Mar 2020, jrheum.190974; DOI: 10.3899/jrheum.190974

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Accepted manuscript
Epidemiology of depression and anxiety in gout: A systematic review and metaanalysis
Alyssa Howren, Drew Bowie, Hyon K. Choi, Sharan K. Rai, Mary A. De Vera
The Journal of Rheumatology Mar 2020, jrheum.190974; DOI: 10.3899/jrheum.190974
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