Session Information
Session 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,
5;
M. Aringer,
AbbVie, Pfizer, Roche/Chugai,
5,
AbbVie, Pfizer, Roche/Chugai, UCB,
8;
C. G. Baerwald,
None;
H. Burkhardt,
None;
N. Eby,
None;
G. Fliedner,
None;
B. Gauger,
Roche Pharmaceuticals,
3;
U. Henkemeier,
None;
M. Hofmann,
ChugaiPharma,
3;
S. Kleinert,
None;
C. Kneitz,
None;
C. Pohl,
None;
G. Schett,
None;
M. Schmalzing,
None;
A. K. Tausche,
None;
H. P. Tony,
Roche Pharmaceuticals,
5;
J. Wendler,
None.
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