Division of Rheumatology, Department of Medicine, School of Medicine, Showa University Tokyo, Japan
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Yusuke Miwa1, Yuko Miwa-mitamura2, Hiroi Tomioka3 and Michio Hosaka4, 1Division of Rheumatology, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan, 2Department of Nursing, Showa University School of Nursing and Rehabilitation Sciences, Tokyo, Japan, 3Department of Psychiatry, School of Medicine, Showa University, Yokohama, Japan, 4Department of psychosomatic medicine, Katsuyama Clinic, Fujikawaguchiko, Japan
Background/Purpose: It has been reported that about 15% of patients with rheumatoid arthritis (RA) have depression, and most of these studies have used questionnaire methods. For example, the Patient Health Questionnaire-9 (PHQ-9) and Center for Epidemiologic Studies Depression Scale (CES-D) questionnaires were used; a score of 10 or more on the PHQ-9 and 16 or more on the CES-D was considered a cutoff. Most of the studies have used questionnaires for depression. Because the depression questionnaire includes questions about physical symptoms, it is necessary to interpret the results carefully when there is an underlying disease. In addition, there are no studies on other mental disorders. In this study, we examined the validity of the questionnaire method for diagnosing RA complicated by psychiatric disorders and searching for optimal cutoff values in patients with rheumatoid arthritis.
Methods: One hundred twenty-three outpatients with RA who agreed to participate in this study were included. Age, gender, type of Disease-modifying anti-rheumatic drugs, prednisolone use, presence of diabetes, hypertension, dyslipidemia, and CRP were investigated. The PHQ-9 and CES-D questionnaires were used. The psychiatrist was blinded to the questionnaire results and conducted a structured interview in a separate room. The psychiatrist's diagnosis was defined as the Gold Standard and was compared with the PHQ-9 and CES-D.
Results: Twenty-three patients were excluded. Seven patients disagreed and withdrew their consent, and 16 could not adjust their schedules. The psychiatrist's diagnosis was abnormal in 15 patients. This included one patient with major depression, two patients with moderate depression, five patients with minor depression, two patients with adjustment disorder, two patients with neurosis, one with anxiety, one with insomnia, and one with mental retardation. The Receiver Operating Characteristic curve produced the following cutoff values. A score of 3 or more on the PHQ-9 and 17 or more on the CES-D was considered a cutoff. The PHQ-9 had a specificity of 62.4%, a sensitivity of 93.3%, and the area under the curve (AUC) was 0.792 (95%CI 0.674-0.91). The CES-D had a specificity of 89.4%, a sensitivity of 73.3%, and an AUC was 0.881 (95%CI 0.808-0.955).
Conclusion: The PHQ-9 and CES-D may be helpful in screening for psychiatric disorders, including those associated with RA. However, a different cutoff value should be used than the standard cutoff value.
Y. Miwa: None; Y. Miwa-mitamura: None; H. Tomioka: None; M. Hosaka: None.
