Association Between Rheumatoid Arthritis and Depressive Symptoms: A Population-Based Analysis from the Paracelsus 10,000 Study

• Depression was more than twice as common in individuals with rheumatoid arthritis. • Findings are based on 9,401 participants from the Paracelsus 10,000 population study. • The association remained robust after full adjustment for confounders. • Results emphasize the bidirectional link between inflammation and mood. • Study supports integrated care between rheumatology and psychiatry. Depression is common in the general population and may occur more frequently in individuals with rheumatoid arthritis (RA). This study examined the association between RA and depressive symptoms in a population-based cohort from Salzburg, Austria. Data were obtained from the Paracelsus 10,000 cohort, comprising 9,401 participants. RA was determined according to the EULAR/ACR classification criteria and verified through structured baseline interviews and medical documentation. Depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II). Depression was defined as a BDI-II score >13, according to national guidelines. Logistic regression analyses were used to estimate the association between RA and depression, and linear regression analyses assessed differences in continuous BDI-II scores. Models were adjusted sequentially for demographics, socioeconomic, and clinical covariates. Among 293 participants with RA and 9,108 without RA, elevated depressive symptoms were present in 20% and 9%, respectively. RA was associated with higher odds of elevated depressive symptoms in unadjusted analyses (OR 2.48, 95% CI 1.84–3.35; p<0.001), after adjustment for age and sex (OR 2.39, 95% CI 1.76–3.23; p<0.001), and in fully adjusted models (OR 2.10, 95% CI 1.52–2.89; p<0.001). Median BDI-II scores were higher in participants with RA compared to those without RA (6 [IQR 2–11] vs. 3 [IQR 0–7]; p<0.001). In linear regression analyses, RA was associated with a mean increase of 3.40 BDI-II points (95% CI 2.65–4.14; p<0.001), exceeding the minimal clinically important difference. In this population-based cohort, RA was statistically associated with higher depressive symptoms after adjustment for demographic, socioeconomic and clinical covariates. Given the cross-sectional design, causal inferences cannot be drawn. These findings support routine depression screening and integrated care for patients with RA. Moreover, the bidirectional link between rheumatic and psychiatric conditions highlights that psychiatrists should consider underlying rheumatic disease in patients presenting with depression, fatigue or unexplained pain.