Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Association of Depressive Symptoms and Helplessness with Socioeconomic Status in People with Knee Osteoarthritis.

Callahan2,  Leigh F., Shreffler4,  Jack H., Martin3,  Kathryn Remmes, Schoster4,  Britta, Renner4,  Jordan, Jordan1,  Joanne M.

Chapel Hill, NC
Univ of North Carolina, Chapel Hill, NC
University of North Carolina at Chapel Hill, Chapel Hill, NC
University of North Carolina, Chapel HIll


Individual and community socioeconomic status (SES) variables have been demonstrated to be associated with psychosocial outcomes in self-report and other types of arthritis, but these associations have not been examined in knee osteoarthritis to date. The purpose of this study is to evaluate associations between educational attainment, occupational status, and community poverty rate with depressive symptoms and perceived helplessness in people with knee OA.


A cross-sectional analysis was performed using data from 3085 people in the first follow-up evaluation (2000–2003) of the Johnston County Osteoarthritis Project. Depressive symptoms were measured with the 20-item Center for Epidemiologic Studies Depression (CES-D) on a scale of 0–60. Perceived helplessness was measured with the 5-item Rheumatology Attitudes Index (RAI) on a scale of 1–5. Educational attainment was dichotomized as less than high school (HS) diploma or at least a HS diploma. Occupational status was dichotomized as high (e.g. professional, managerial, technical, sales) versus low (labor, service, farm, manufacturing) based on U.S. Census 2000 categories for self-reported occupation. Community poverty was defined from the U.S. Census household poverty rate for the block group in which the participant resided. Poverty rate was trichotomized as <12% (reference), 12–25%, and >25%. Separate analyses were performed for those people having knee radiographic OA (rOA), defined as KL grade>=2 in one or both knees, and for those with symptomatic knee OA (sOA) defined as KL grade >=2 and with symptoms (pain or stiffness) in the same knee. Regression analyses were used to relate CES-D and RAI outcomes to all SES variables while controlling for age, gender, race, and BMI.


Of the sample, 750 people had rOA. The average age was 67 years (45–94), 36% were African American, 58% had BMI >= 30, and 64% were female. 37% of the population had less than HS diploma, and 60% were in non-managerial occupations. The average CES-D was 6.9 (8.1), and the average RAI was 2.55 (0.71). Of those with rOA, 488 also met the definition of sOA. For people with knee rOA, CES-D scores were significantly higher for those with low educational attainment (b=2.04, C.I.=[0.77, 3.3]) and, independently, low occupational status (b=1.58 [0.33, 2.8]). RAI scores were significantly associated only with educational attainment (b=0.31 [0.19, 0.43]). Important covariates for CES-D were age >= 65 (b=-4.8 [-6.5, -3.2]) and being female (b=3.3 [2.1, 4.4]). Important covariates for RAI are being female (b=0.16 [0.05, 0.27]) and having BMI>=30 (b=0.25 [0.14, 0.37]). For people with knee sOA, results generally paralleled those for rOA, except that CES-D was not independently associated with occupational status. Community poverty was not significantly associated with CES-D or RAI in bivariate or multivariable analyses.


Low educational attainment is associated with higher levels of depression and feelings of helplessness in people with knee OA. Low occupational status may also play an independent role.

To cite this abstract, please use the following information:
Callahan, Leigh F., Shreffler, Jack H., Martin, Kathryn Remmes, Schoster, Britta, Renner, Jordan, Jordan, Joanne M.; Association of Depressive Symptoms and Helplessness with Socioeconomic Status in People with Knee Osteoarthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2140
DOI: 10.1002/art.29904

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