Background/Purpose:

The Multidimensional Health Assessment Questionnaire (MDHAQ) was designed to assess quality of life impairment including psychological distress in rheumatoid arthritis (RA) patients. In addition to ten questions addressing the patient’s physical activity (Q1-10), MDHAQ also includes the following three questions (4-point scale: 0, 1, 2, and 3), which address the psychological state of the patient: “Get a good night’s sleep?”(Q11), “Deal with feelings of anxiety or being nervous?”(Q12), and “Deal with feelings of depression or feeling blue?”(Q13). The utility of these questions has yet to be investigated.

The purpose of the study is to identify RA patients suffering from anxiety and depression using MDHAQ in daily clinical practice

Methods:

A previously validated Japanese version of MDHAQ was used in this study [1]. Hospital Anxiety and Depression Scale (HADS) was used to detect RA patients suffering from anxiety and depression. The validation of MDHAQ (Q11, Q12, and Q13) included test-retest reliability, content validity, and concurrent validity.

Results:

A total of 348 patients were included in this study. Mean (SD) age and disease duration in the validation study population were 65.2 (12.1) years and 11.4 (10.5) years, respectively.

The proportion of cases with possible anxiety (HADS-Anxiety (HADS-A) ≥8) and probable anxiety (HADS-A ≥11) was 7.9% and 21.4%, respectively, whereas the proportion of cases with possible depression (HADS-Depression (HADS-D) ≥8) and probable depression (HADS-D ≥11) was 7.9% and 24.7%, respectively.

The test-retest reliability of Q11, Q12, and Q13 (50 patients) was 0.730, 0.757, and 0.708 (Spearman’s rank correlation coefficient), respectively. The internal reliability of Q11, Q12, and Q13 was 0.930, 0.628, and 0.680 (Chronbach’s α), respectively. The correlation between Q11 and 12, Q11 and 13, and Q12 and 13 was 0.503, 0.463, and 0.891 (Spearman’s rank correlation coefficient), respectively. The correlation between Q12 and HADS-A, and Q13 and HADS-D was 0.557 and 0.420 (Spearman’s rank correlation coefficient), respectively.  

In screening for patients with probable anxiety, Q12 ≥1 showed a sensitivity of 82.6 % and a specificity of 40.6% while Q12 ≥2 showed a sensitivity of 21.7% and a specificity of 98.6%. In screening for cases with probable depression, Q13 ≥1 showed a sensitivity of 62.5% and a specificity of 68.7% while Q13 ≥2 showed a sensitivity of 8.3% and a specificity of 97.9%. Among the 7 ACR Core Data Set measures, all 3 patient-reported outcomes (patient global assessment, pain VAS, and HAQ) and tender joint counts were significantly worse in patients with Q13 ≥1 than in patients with Q13=0 but other 3 ACR Core Data Set measures (swollen joint count, physician global assessment, and acute phase reactants) were similar for both groups.

Conclusion:

MDHAQ was found to be suitable for use in daily practice for identifying RA patients with probable anxiety and depression. 

Reference:

[1] Yokogawa N, et al. Validation of RAPID3 using a Japanese version of Multidimensional Health Assessment Questionnaire with Japanese rheumatoid arthritis patients: characteristics of RAPID3 compared to DAS28 and CDAI. Mod Rheumatol 2015;25(2):264-9.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/identifying-anxiety-and-depression-among-rheumatoid-arthritis-patients-using-the-multidimensional-health-assessment-questionnaire/