ORIGINAL ARTICLE Psychological factors and quality of life in arthritis: a population-based study Catherine L. Hill & Tiffany Gill & Anne W. Taylor & Alison Daly & Eleonora Dal Grande & Robert J. Adams Received: 8 March 2006 / Revised: 7 September 2006 / Accepted: 7 September 2006 / Published online: 18 October 2006 # Clinical Rheumatology 2006 Abstract Previous studies using clinic or convenience samples have indicated that not only patients with arthritis are at increased risk of depression, but there may also be a link between depression and disability in people with arthritis. We examined the prevalence of psychological distress in a population sample with and without arthritis and the association with health-related quality of life. The WANTS Health and Well-being Survey was a population household telephone interview survey of adults (age ≥18 years) in three states of Australia. Data obtained were weighted to provide population-representative estimates. The survey included questions regarding arthritis, SF-12, the Kessler 10 index of psychological distress and presence of mental health conditions. A total of 7,473 interviews providing information on arthritis were completed, with 1,364 (18.3%) reporting arthritis. Self-reported mental health conditions were more frequent in those with arthritis (14.9 vs 12.0%, p =0.004), and a higher proportion were at a medium or high risk for anxiety or depression (39.0 vs 31.0%, p <0.001). People with arthritis had significantly lower scores on the SF-12 physical component summaries compared to those without arthritis. Among those with arthritis, those with coexisting psychological distress had significantly lower scores on the SF-12 physical component summary than those without psychological distress. Psy- chological distress is common among people with arthritis in the community. In arthritis, psychological distress makes a significant additional negative impact on the physical well-being. Physicians need to recognize and address this additional impact on physical functioning in patients with arthritis. Keywords Arthritis . Population-based study . Psychological distress Introduction Previous studies of the role of psychological distress and depression in rheumatic diseases have generally been restricted to clinic populations and convenience samples [1–4]. These studies have suggested that the prevalence of self-reported depression amongst those with rheumatoid arthritis (RA) in clinic population range from 15 to 40% [2, 3, 5]. Data from National Health and Nutrition Examination Survey I (NHANES I) suggested that 18% of the population with chronic musculoskeletal pain had depres- sion compared to 8% of the population without chronic pain [6]. Population studies of people with chronic pain have noted the association of pain with psychological distress and increased risk of mental disorders [7, 8]. These studies examined people with chronic musculoskeletal pain rather than those with a diagnosis of arthritis. Therefore, the combined burden of psychological distress and arthritis in the community is unknown. Clin Rheumatol (2007) 26:1049–1054 DOI 10.1007/s10067-006-0439-3 C. L. Hill (*) Rheumatology Unit, The Queen Elizabeth Hospital, 28 Woodville Rd, Woodville, South Australia 5011, Australia e-mail: Catherine.Hill@nwahs.sa.gov.au T. Gill : A. W. Taylor : E. D. Grande Population Research and Outcome Studies Unit, Department of Health, Adelaide, South Australia, Australia A. Daly Health Outcomes Assessment Unit, WA Department of Health, Perth, Western Australia, Australia R. J. Adams The Health Observatory, University of Adelaide, Adelaide, South Australia, Australia