The association between gout and psychological co-morbidity: results from a prospective cohort study

Abstract

Gout is associated with an increased risk of both physical-health co-morbidities and a reduction in physical health-related quality of life. However, the association between gout and psychological comorbidity (depression and anxiety) has received little attention. A systematic review of the existing knowledge between gout and psychological co-morbidity was conducted. Then, a secondary analysis of a five-year prospective cohort study was performed to determine the prevalence, incidence, and gout characteristics associated with psychological co-morbidity.

The systematic review included 15 articles: all examined depression, whereas seven reported on anxiety, in people with gout. The prevalence of depression (11.8 to 49.4%), and anxiety (5.3 to 22.9%) was common. Depression incidence varied (3.13 to 25.50 per 1000 person-years), whereas anxiety incidence was 15.2 per 1000 person-years. Greater flare frequency, and having more joints affected were associated with psychological co-morbidity.

The secondary analysis comprised 1184 baseline responders with gout, 411 by five years. The prevalence of depression and anxiety peaked at 12.6% and 10.0%, respectively. Over five years, one in twelve developed new-onset anxiety, and one in eleven developed new-onset depression. A baseline history of oligo- or poly-articular gout flares were associated with developing anxiety (OR 2.31, 95% CI: 1.26 to 4.23). However, flare frequency, gout duration, or allopurinol use were not. Allopurinol use at baseline was associated with developing depression (OR 1.93, 95% CI: 1.01 to 3.69). However, flare frequency, gout duration, or oligo- or poly-articular gout were not.

Psychological co-morbidity is common in people living with gout; clinicians should be aware of this mental health need and the characteristics identified associated with increased risk of psychological co-morbidity to focus surveillance and maximise holistic care. Further studies into gout and psychological co-morbidity (particularly of prospective design and featuring anxiety) are recommended to further strengthen and elucidate these findings.