Oral Presentation ARA-NSW 2020 - 42nd Annual NSW Branch Meeting

Screening for depression and anxiety in patients with rheumatoid arthritis and psoriatic arthritis (#4)

Sadia Islam 1 , Geraldine Hassett 1 , Kathryn Gibson 1
  1. Rheumatology, Liverpool Hospital, Liverpool, NSW, Australia

Background: Depression and anxiety are more prevalent in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) compared with the general population1, 2, and are associated with reduced remission rates and worse quality of life3, 4. However, comorbid mood disorders can be under-recognised and under-treated by non-psychiatric physicians5, resulting in poorer patient outcomes. 

Objectives: (1) To evaluate the multidimensional health assessment questionnaire (MDHAQ) in screening for depression and anxiety in comparison to the hospital anxiety and depression scale (HADS). (2) To evaluate the relationship between patient-reported depression and anxiety and measures of disease activity. (3) To assess the impact of implementing a disease-specific questionnaire on clinician recognition, assessment and treatment decisions regarding depression and anxiety.

Methods: Patients with a primary diagnosis of RA or PsA complete the MDHAQ at each visit, which includes two items each related to depression and anxiety. From 2019, patients also completed the HADS at each visit. Percent agreement and kappa statistics were used to quantify agreement between MDHAQ items and HADS>/=8. RAPID-3, self-report joint count (RADAI), ESR and CRP were compared between patients with and without self-reported depression or anxiety. Medical records were reviewed to determine the rate of clinician documentation regarding depression or anxiety prior to and after the implementation of HADS.

Results: 215 patients completed the MDHAQ and HADS, of which 151 had RA and 64 had PsA. The RA group had more females (78.2% vs 46.9%, p<0.0001) and were older (59.4 vs 52.9 years, p<0.005) compared with the PsA group. Of the whole population, 39.3% had a HADS-D>/=8, and 43.7% had a HADS-A>/=8, with no significant difference between RA and PsA groups. 183 patients completed a RAPID-3, with higher scores in patients with a HADS-D>/=8 (15.4 vs 9.1, p<0.0001) and HADS-A>/=8 (14.9 vs 8.9, p<0.0001). Further results to be presented.

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  2. 2. McDonough, E., Ayearst, R., Eder, L., Chandran, V., Rosen, C.F., Thavaneswaran, A. & Gladman, D.D. Depression and anxiety in psoriatic disease: prevalence and associated factors. The Journal of Rheumatology, 2014, 41(5), 887-896.
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  4. 4. Machin, A.R., Babatunde, O., Haththotuwa, R., Scott, I., Blagojevic-Bucknall, M., Corp, N., Chew-Graham, C.A. & Hider, S.L. The association between anxiety and disease activity and quality
of life in rheumatoid arthritis: a systematic review and meta-analysis. Clinical Rheumatology, 2020, 39(5), 1471-1482.
  5. 5. Cepoiu, M., McDusker, J., Cole, M.G., Sewitch, M., Belzile, E. & Ciampi, A. Recognition of depression by non-psychiatric
physicians—a systematic literature review and meta-analysis. Journal of General Internal Medicine, 2008, 23(1), 25-36.