High Prevalence of Depressive Symptoms Among Ugandan Patients with Rheumatoid Arthritis

Figures & data

Table 1 Characteristics of the Patients

Variables	Frequency or Median	% or IQR
Hospital
Mulago Hospital	29	60.4
Nsambya Hospital	19	39.6
Sex
Female	44	91.7
Male	4	8.3
Age; median (IQR)	52	43.5–60.5
<52	23	47.9
≥52	25	52.1
Marital status
Single	16	33.3
Married	15	33.3
Divorced	6	12.5
Widow(er)	11	22.9
Education level
Informal	5	10.4
Primary	14	29.2
Secondary	10	20.8
Tertiary	19	39.6
Employment status
Formal	15	31.3
Informal	33	68.8
Income; median (IQR), Uganda shillings	100,000	50,000–450,000
<100,000	4	26.7
≥100,000	11	73.3
Financial support from family
Yes	36	75.0
No	12	25.0
Duration of illness in months; median (IQR)	60	24–120
≤1 year	23	47.9
>1 year	25	52.1
Self-reported disease severity
Controlled	6	12.5
Mild	9	18.8
Moderate	18	37.5
Severe	11	22.9
Very severe	4	8.3
Clinic visits in last 12 months	4	3–6
Disease flares in last 3 months	1	0–2
Hospital admissions in last 12 months	0	0–0
Regimen
Methotrexate alone	23	47.9
Hydroxychloroquine alone	8	16.7
Hydroxychloroquine + Methotrexate	8	16.7
Methotrexate + Leflunomide	6	12.5
Hydroxychloroquine + Azathioprine	2	4.2
Hydroxychloroquine + Methotrexate + Leflunomide	1	2.1
Duration on DMARDS; median (IQR)	12	4–36
≤48 months	26	57.8
>48 months	19	42.2
Source of DMARDS
Nsambya Hospital	14	29.2
Private pharmacy	34	70.8
Monthly cost of DMARDS	120,000	60,000–150,000
Satisfaction with medical treatment
Yes	40	83.3
No	8	16.7
Herbal medicine used
Yes	11	22.9
No	37	77.1
Does DMARDS affect your daily activity?
Yes	5	10.4
No	43	89.6
Adverse drug reactions to DMARDS
Yes	16	33.3
No	32	66.7
Co-morbidities
Yes	29	60.4
No	19	39.6
Hypertension	26	54.2
Diabetes	3	6.3
Chronic Heart Failure	2	4.2
Chronic Lung Disease	1	2.1
HIV	1	2.1
Coronary artery disease	1	2.1
Charlson Comorbidity index	3	2.0–4.0
Adherence
High	33	68.8
Low	15	31.3
Health index value	0.6	0.5–0.7
Overall self-rated health status	55	50–65

Abbreviations: HIV, human immunodeficiency virus; DMARDS, disease modifying anti-rheumatic drugs; IQR, inter-quartile range.

Table 2 Prevalence and Factors Associated with Depressive Symptoms Among Patients with Rheumatoid Arthritis Among Patients at Mulago and Nsambya Hospitals

Variables	Depressive Symptoms		p-value
	Yes	No
Overall	34 (70.8)	14 (29.2)
Hospital
Mulago Hospital	24 (82.8)	5 (17.2)	0.025
Nsambya Hospital	10 (52.6)	9 (47.4)
Sex
Male	2 (50)	2 (50)	0.569
Female	32 (72.7)	12 (27.3)
Age; mean (SD)	46.5 (35.0–58.0)	60 (52–65)	0.015
<50	20 (87)	3 (13)	0.027
≥50	14 (56)	11 (44)
Marital status
Single	13 (81.3)	3 (18.8)	0.721
Married	10 (66.7)	5 (33.3)
Divorced	4 (66.7)	2 (33.3)
Widow(ed)	7 (63.6)	4 (36.4)
Education level
Informal	2 (40)	3 (60)	0.401
Primary	11 (78.6)	3 (21.4)
Secondary	8 (80)	2 (20)
Tertiary	13 (68.4)	6 (31.6)
Employment status
Formal	12 (80)	3 (20)	0.498
Informal	22 (66.7)	11 (33.3)
Income; median (IQR)	150,000 (75,000–470,000)	100,000 (50,000–450,000)	0.770
<100,000	3 (75)	1 (25)	0.770
≥100,000	9 (81.8)	2 (18.2)
Financial support from family
Yes	25 (69.4)	11 (30.6)	0.714
No	9 (75)	3 (25)
Duration of illness; median (IQR)		66 (48–120)	0.275
≤1 year	18 (78.3)	5 (21.7)	0.278
>1 year	16 (64)	9 (36)
Disease severity
Controlled	2 (33.3)	4 (66.7)	0.128
Mild	5 (55.6)	4 (44.4)
Moderate	15 (83.3)	3 (16.7)
Severe	9 (81.8)	2 (18.2)
Very severe	3 (75)	1 (25)
Clinic visits in last 12 months	4 (3–6)	4.5 (3.0–6.0)	0.845
Disease flares in last 3 months	1 (1–2)	1 (0–1)	0.138
Hospital admissions in last 12 months	0 (0–1)	0 (0–0)	0.083
Family history of autoimmune diseases
Yes	3 (42.9)	4 (57.1)	0.171
No	31 (75.6)	10 (24.4)
Regimen
Methotrexate	17 (73.9)	6 (26.1)	0.573
Hydroxychloroquine	7 (87.5)	1 (12.5)
Hydroxychloroquine + Methotrexate	5 (62.5)	3 (37.5)
Methotrexate + Leflunomide	3 (50)	3 (50)
Hydroxychloroquine + Azathioprine	1 (50)	1 (50)
Hydroxychloroquine + Methotrexate + Leflunomide	1 (100)	0 (0)
Duration on DMARDS; median (IQR)	12 (4–36)		0.867
≤48 months	19 (73.1)	7 (26.9)	0.964
>48 months	14 (73.7)	5 (26.3)
Source of DMARDS
Nsambya Hospital	8 (57.1)	6 (42.9)	0.181
Private pharmacy	26 (76.5)	8 (23.5)
Monthly cost of DMARDS	110,000 (33,600–148,000)	135,000 (97,000–190,000)	0.154
Satisfaction with medical treatment
Yes	27 (67.5)	13 (32.5)	0.407
No	7 (87.5)	1 (12.5)
Adverse drug reactions to DMARDS
Yes	13 (81.3)	3 (18.8)	0.328
No	21 (65.6)	11 (34.4)
Co-morbidities
Yes	14 (60.9)	9 (39.1)	0.145
No	20 (80)	5 (20)
Charlson Comorbidity index	2.5 (2–4)	3 (3–4)	0.353
Adherence
High	22 (66.7)	11 (33.3)	0.498
Low	12 (80)	3 (20)
Index value	0.6 (0.4–0.7)	0.7 (0.7 −0.8)	<0.001
Visual analogue scale	50 (50–60)	62.5 (50–75)	0.013

Abbreviations: DMARDS; disease modifying anti-rheumatic drugs; IQR, inter-quartile range.

Figure 1 Prevalence and severity of depressive symptoms among patients with rheumatoid arthritis in Uganda.

Table 3 A Binary Logistic Regression Showing Factors Associated with Depressive Symptoms Among Patients with RA

Variables	Crude Odds Ratio	95% CI	P-value
Hospital
Nsambya Hospital	1.00
Mulago Hospital	4.32	1.16–16.15	0.030
Age, years	0.94	0.89–0.99	0.025
Age category, years
≥52	1.00
<52	5.24	1.23–22.28	0.025
Self-reported disease severity
Controlled	1.00
Mild	5.71	1.15–28.35	0.033
Moderate	5.14	0.82–32.3	0.081
Severe	3.43	0.29–40.95	0.33
Visual analogue scale	0.94	0.89–0.99	0.013

Abbreviation: CI, confidence interval.