Explaining the gap in the experience of depression among arthritis patients

Manasi M. Mittinty, James M. Elliott, David J. Hunter, Michael K. Nicholas, Lyn M. March, Murthy N. Mittinty

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Objective: To explain the factors contributing to the gap in depression between employed arthritis patients with and without paid sick leave. 

Methods: Blinder-Oaxaca decomposition analysis was used to identify factors that explain the gap in the experience of depressive symptoms among arthritis patients with paid and unpaid sick leave. Data from the 2018 National Health Interview Survey, USA, was used. 

Results: A total of 7189 of the NHIS survey participants given the diagnosis of arthritis were identified, of which 39% were male and 61% were female, with mean age of 63.5 years. The decomposition findings suggest patients in the unpaid sick leave group were more likely to report depressive symptoms compared to patients with paid sick leave. The major contributors to the gap in the report of depressive symptoms are sex (female) and annual income (less than 35,000 USD). 

Conclusion: Findings suggest that the absence of paid sick leave is a key determinant for experiencing depressive symptoms among individuals with arthritis. The provision of paid sick leave may reduce report of depressive symptoms among employed arthritis patients in the USA. 

Key Points: 

• Individuals with arthritis are consistently at greater risk of depression and unemployment as compared to individuals without arthritis. 

• To date greater emphasis is put on determinants of unemployment, while there is no available data on benefits associated with being employed, such as sick leave, and how it affects mental health. 

• Patients with unpaid sick leave appear to experience more persistent depressive symptoms than patients with access to paid sick leave. 

• To tackle burden of depression among arthritis patients, provision of paid sick leave may be an effective intervention.

Original languageEnglish
Pages (from-to)1227-1233
Number of pages7
JournalClinical Rheumatology
Issue number4
Early online date7 Jan 2022
Publication statusPublished - Apr 2022
Externally publishedYes


  • Arthritis
  • Depression
  • Employment
  • Paid sick leave
  • Unpaid sick leave


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