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.
The Performance of the Hospital Anxiety and Depression Scale for Screening of Depressive and Anxiety Disorders in Patients with Rheumatoid Arthritis (RA).
Lok1, Eugenia Y. C., Mok2, Chi Chiu, Cheung1, Fuk Chi, Cheng1, Chi Wai
To evaluate the performance of the Hospital Anxiety and Depression Scale (HADS) for screening of depressive and anxiety disorders in patients with rheumatoid arthritis.
200 consecutive Chinese patients who fulfilled the ACR criteria for RA were recruited from an out-patient rheumatology clinic. Written consent was obtained from these patients who were then interviewed by a psychiatrist for the presence of depressive disorders and anxiety disorders using the Chinese-bilingual Structured Clinical Interview for DSM-IV Axis I disorders, Patient research version (CB-SCID-I/P). Patients were invited to complete a validated Chinese version of the HADS questionnaire (depression sub-score 021; anxiety sub-score 021) before the psychiatric interview. Socio-demographic and clinical data such as age, gender, duration of RA, disease activity scores (DAS28), pain, income and education level at the time of interview were also collected. The sensitivity and specificity of the cut-off scores of the HADS depression and anxiety subscale for the clinical diagnosis of depressive or anxiety disorders was evaluated by the receiver operating curve (ROC) analysis.
Between July 2007 and June 2008, 200 patients with RA were studied (79% women, mean age 51.4±10.5 years; median RA duration 4.0 years [IQR 2.09.0]). 47 (23.5%) patients were diagnosed to have a current psychiatric disorder (depressive disorders 14.5%, anxiety disorders 13%). Major depressive disorder was the commonest current mood disorder whereas generalized anxiety disorder was the most common current anxiety disorder. The mean depression sub-score of HADS in RA patients who were diagnosed to have depressive disorders was 13.1±3.1, which was significantly higher than that in patients without depressive disorders (5.7±3.5; p<0.001). On the other hand, the mean anxiety sub-score of the HADS in patients with anxiety disorders was also significantly higher than those without anxiety disorders (11.2±3.4 vs 5.4±3.9; p<0.001). Using ROC analysis, the optimal cut-off score of the HADS depression subscale was 10 for the presence of depressive disorders, yielding a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 90%, 85%, 50% and 98%, respectively (area under the ROC: 93%). The optimal cut-off score of the anxiety subscale of HADS was 8 for the presence of anxiety disorders, with a sensitivity of 89%, specificity of 74%, PPV of 34% and NPV of 98% (area under the ROC: 87%).
As a screening tool, the HADS perform better for depressive disorders than anxiety disorders in patients with RA. A cut-off of 10 points in the HADS depression subscale yields a good sensitivity and specificity for picking up depressive disorders.
To cite this abstract, please use the following information:
Lok, Eugenia Y. C., Mok, Chi Chiu, Cheung, Fuk Chi, Cheng, Chi Wai; The Performance of the Hospital Anxiety and Depression Scale for Screening of Depressive and Anxiety Disorders in Patients with Rheumatoid Arthritis (RA). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1777