Evaluating Depression Questionnaires In German Rheumatoid Arthritis Patients – Preliminary Results From a Validation Study

Matthias Englbrecht¹, Rieke Alten², Martin Aringer³, Christoph G. Baerwald⁴, Harald Burkhardt⁵, Nancy Eby⁶, Gerhard Fliedner⁷, Bettina Gauger⁸, Ulf Henkemeier⁹, Michael Hofmann¹⁰, Stefan Kleinert¹¹, Christian Kneitz¹², Christoph Pohl¹³, Georg Schett¹, Marc Schmalzing¹⁴, Anne-Kathrin Tausche¹⁵, Hans Peter Tony¹⁶ and Joerg Wendler¹⁷, ¹Dept of Medicine 3, Rheumatology and Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany, ²Teaching Hospital of the Charité, University of Berlin, Berlin, Germany, ³Rheumatology, Medicine III, University Clinical Center Technical University of Dresden, Dresden, Germany, ⁴Rheumatology, University Hospital, Leipzig, Germany, ⁵CIRI /Div. of Rheumatology, Goethe-University, Frankfurt/Main, Germany, ⁶Biostatistics, AMS-Advanced Medical Services, Mannheim, Germany, ⁷Praxis Osnabrück, Germany, Germany, Osnabrück, Germany, ⁸Roche Pharma AG, Grenzach, Germany, ⁹University Hospital Frankfurt, Frankfurt, Germany, ¹⁰Chugai Pharma, Frankfurt, Germany, ¹¹Rheumatology/Clinical Immunology,, University Hospital Würzburg, Würzburg, Germany, ¹²Internal Medicine II, Hospital Südstadt, Rostock, Germany, ¹³Rheumatology,Clinical Immunolo, Schlosspark Klinik, Berlin, Germany, ¹⁴Rheumatology/Clinical Immunology, University Hospital Würzburg, Würzburg, Germany, ¹⁵Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany, ¹⁶Rheumatology/Immunology, University of Würzburg, Würzburg, Germany, ¹⁷Schwerpunktpraxis Rheumatologie, Erlangen, Germany

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: depression, questionnaires and rheumatoid arthritis (RA), Validity

Session Information

Title: Rheumatoid Arthritis-Clinical Aspects III: Outcome Measures, Socioeconomy, Screening, Biomarkers in Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose:

To date, only a few studies have discussed the prevalence of depression in RA patients in Germany and depression questionnaires have not been validated for use in RA patients in the German language. This was the aim of the first part of the Validation of Depression Questionnaires for Patients with Rheumatoid Arthritis (VADERA) study presented in this abstract.

To evaluate the construct validity, retest reliability and sensitivity to change of the following four tools measuring depressiveness: the WHO five well-being index (WHO-5), the patient health questionnaire (PHQ‑9), the Beck Depression Inventory (BDI-II), and Montgomery-Åsberg Depression Rating Scale (MADRS).

Methods:

A patients with no previous history of depressive disorders were asked to complete the WHO-5, PHQ-9 and BDI-II questionnaires and a subsequent structured interview (MADRS) at 2 time-points with a 10-14 week interval between assessments. Additional information on demography (e.g. age, sex, disease duration) and disease activity (e.g. CRP, ESR, disease activity score 28 [DAS28]) was collected.

In order to evaluate convergent and discriminant validity as subsets of construct validity, we calculated Pearson correlations of the PHQ-9, WHO-5, BDI-II, and MADRS at both time-points (= convergent) followed by Pearson correlation of the depression scores with age and DAS28 (= discriminant). Results from patients who had no psychotherapeutic intervention for depression and who had a change of < 0.6 in DAS28 between the first and second time-point were evaluated for the retest reliability of the instruments (i.e. a Pearson correlation). Sensitivity to change was evaluated among patients who had received psychotherapeutic intervention between the first and second time-point using the standardized response mean (SRM).

Results:

277 RA patients from 9 centers in Germany were evaluated in VADERA I. Baseline characteristics were: mean (±SD) age 60 (±13.0) years, 79% female, mean duration of disease 12.4 (± 9.4) years, 61% anti‑citrullinated protein antibody positive and a mean DAS28 score 3.5 (± 1.6). 10.0% of the patients were undergoing anti-depressive therapy.

All Pearson correlations for convergent validity showed statistically significant correlations at both time-points. Corresponding coefficients ranged from r=0.63 (p<0.001) (PHQ-9 with BDI-II) to r= 0.79 (p<0.001) (BDI-II with MADRS) and from r= -0.36 (p<0.001) (WHO‑5 with MADRS) to r=-0.54 (p<0.001) (WHO‑5 with PHQ-9).

Correlations of discriminant validity ranged from r= -0.14 (p=0.05) (PHQ-9) to r= 0.17 (p=0.01) (WHO‑5) for age and from r= ‑0.22 (p=0.002) (WHO‑5) to r=0.43 (p<0.001) (MADRS) for disease activity.

All questionnaires showed good retest reliability which ranged from r= 0.68 (p<0.001) for the PHQ-9 to r= 0.85 (p<0.001) for the WHO-5.

The SRMs were rather small and ranging from ‑0.37 (n=12, BDI-II) to 0.13 (n=14, PHQ-9), suggesting the BDI-II to be most sensitive to changes in depression status.

Conclusion:

Especially the PHQ-9, the BDI-II, and the MADRS may be assumed to be construct valid and retest reliable. SRMs were rather small and suggesting the BDI-II to be most sensitive.

Disclosure:

M. Englbrecht,
None;

R. Alten,

Horizon Pharma, Inc,

M. Aringer,

AbbVie, Pfizer, Roche/Chugai,

AbbVie, Pfizer, Roche/Chugai, UCB,

C. G. Baerwald,
None;

H. Burkhardt,
None;

N. Eby,
None;

G. Fliedner,
None;

B. Gauger,

Roche Pharmaceuticals,

U. Henkemeier,
None;

M. Hofmann,

ChugaiPharma,

S. Kleinert,
None;

C. Kneitz,
None;

C. Pohl,
None;

G. Schett,
None;

M. Schmalzing,
None;

A. K. Tausche,
None;

H. P. Tony,

Roche Pharmaceuticals,

J. Wendler,
None.

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