Incident generalized anxiety and common mental disorders in rheumatoid arthritis: a 12-year case-cohort analysis from ELSA-Brasil

Rheumatoid arthritis (RA) is associated with mental health disorders, but longitudinal evidence remains limited. To examine the association of RA with depressive episode, generalized anxiety disorder (GAD), and common mental disorders (CMD) in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). This case-cohort analysis included 1,795 participants: 252 in the RA case group and 1,543 in a randomly selected reference sample. For each incident outcome, participants with the condition at baseline or without follow-up information were excluded. Outcomes were assessed over 12 years of follow-up. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for sociodemographic and clinical covariates. At baseline, depressive episode was present in 19 (7.5%) participants in the RA group and 60 (3.9%) in the reference sample, GAD in 45 (18.1%) and 186 (12.2%), and CMD in 92 (36.5%) and 411 (26.6%), respectively. Fully adjusted ORs for the association of RA with depressive episode, GAD, and CMD were 1.52 (95% CI 0.85–2.74), 1.30 (0.89–1.90), and 1.41 (1.04–1.90), respectively. During follow-up, depressive episode occurred in 24 (14.4%) participants in the RA group and 94 (9.4%) in the reference sample, GAD in 37 (25.2%) and 120 (13.3%), and CMD in 43 (36.4%) and 164 (20.9%), respectively. Corresponding fully adjusted ORs were 1.41 (0.84–2.36), 2.04 (1.30–3.18), and 2.06 (1.33–3.18), respectively. RA was associated with baseline CMD and incident GAD and CMD, but not with baseline depressive episode, baseline GAD, or incident depressive episode after adjustment.