The burden of depression among ambulatory knee and hip osteoarthritis patients at the Kenyatta National Hospital

Abstract

Background: Osteoarthritis (OA) is a degenerative joint disorder arising from biochemical breakdown of articular cartilage and surrounding joint structures. It is the most prevalent type of arthritis and a leading cause of disability world over (1, 2). Prevalence of depression among patients with osteoarthritis has been shown to be higher compared to those without OA(3). Depression is associated with increased pain perception and reduced physical activity leading to increased risk of obesity which further worsens the OA. Prompt diagnosis and treatment of depression among this population improves disease outcomes(4). This has however not been documented in Kenya. The aim of this study was to establish the prevalence of depression among knee and hip osteoarthritis patients and its association with disease severity. Objectives: The main objective of this study was to determine the burden of depression among patients with knee and hip osteoarthritis (KHOA) at the KNH orthopedic and rheumatology clinic. The secondary objective was to determine factors associated with depression in patients with KHOA and the relationship between depression and severity of OA. Methodology: This was a cross sectional descriptive study carried out at the rheumatology and orthopedic clinic in KNH over a period of 1.5 months. The study population was adults aged 18 years and above on follow up for knee or hip osteoarthritis (KHOA).Patients that met the inclusion criteria and gave a written informed consent were enrolled into the study. A study proforma was used to obtain socio-demographic and clinical data. Clinical assessment of the patients BMI was done using a calibrated weighing scale and stadiometer. The patient health questionnaire 9 (PHQ-9) was used to establish presence and degree of depression among participants. The Lequesne algofunctional index was used to determine OA disease severity. Data obtained was entered and analyzed using SPSS version 21.0, Chicago- Illinois. The prevalence of depression was calculated as a proportion of patients with any degree of depression and presented as a percentage. Chi-square test was used to determine the association between presence of depression, and socio-demographic and clinical characteristics. Results: This study involved 164 KHOA patients with a mean age of 59.4±11.1 years and a sex ratio (M:F) of 1:1.7. The prevalence of depression was 17.1% of which 12.8% had mild depression, 3.1% moderate and 1.2% severe. Obesity (p=0.021) and employment status (p=0.023) had a significant association with depression. There was a strong correlation between KHOA disease severity and depression (r 0.779, p=<0.0001). Conclusion: The prevalence of depression is relatively high among ambulatory KHOA patients at KNH. Majority of the participants with depression had mild form of the disease. Participants who were unemployed and obese had increased proportion of depression. There was a strong positive correlation between depression and KHOA disease severity.