The Association of Pain and Sleep in Relation to Depressive Symptoms among Older Adults with Arthritis

Purpose: Data from 2013-2015 showed that arthritis affects 54.4 million adults in the US annually, most (59%) are 65 years or older. Chronic pain is a primary symptom of arthritis and may have widespread consequences on an individual's sleep and mental health. Research suggests that sleep and chronic pain may synergistically impact depression. However, to date no study has examined the joint effect that sleep and chronic pain may have on the development of depressive symptoms. Methods: We used data from the 2010-2016 waves of the Health and Retirement Study (HRS). The study included data from 7,310 individuals with arthritis and free of depressive symptoms at baseline (2010). We performed a multivariable-adjusted Cox proportional hazards regression to estimate the hazard ratio for the joint effect of pain and sleep disorder relative to having neither conditions on the development of depressive symptoms (CESD-R>=3). We calculated the relative excess risk due to interaction, comparing the joint effect with that of pain alone and sleep disorder alone. Analysis was further stratified by sex. Results: There is evidence of a synergistic effect of pain and sleep on risk of depressive symptoms adjusted-HR(95% CI):2.87(2.80,4.99) When stratified by sex a similar synergistic effect as observed in males. Conclusions: Findings from this study suggest that sleep and pain are synergistically linked to the development of depressive symptoms. Understanding the joint effect of pain and sleep on individuals' increased risk of depressive symptoms can help target treatment options for arthritis patients.