Multidimensional Health Assessment Questionnaire as an Effective Tool to Screen for Depression in Routine Rheumatology Care

• Published in: Arthritis care & research (2010) Vol. 73; no. 1; pp. 120 - 129
• Main Authors: Morlà, Rosa M., Li, Tengfei, Castrejon, Isabel, Luta, George, Pincus, Theodore
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.01.2021
• Subjects: Adult; Aged; Agreements; Arthritis, Rheumatoid; Checklist; Comorbidity; Depression - diagnosis; Depression - psychology; Female; Humans; Inflammatory diseases; Male; Medical screening; Mental depression; Middle Aged; Patient Health Questionnaire; Patients; Predictive Value of Tests; Questionnaires; Reproducibility of Results; Rheumatic diseases; Rheumatoid arthritis; Rheumatology; Spondylarthritis; Symptom Assessment
• ISSN: 2151-464X; 2151-4658
• DOI: 10.1002/acr.24467

Objective To analyze the use of the Multidimensional Health Assessment Questionnaire (MDHAQ) to screen for depression, as compared to 2 reference standards, the Patient Health Questionnaire 9 (PHQ‐9) and the Hospital Anxiety and Depression Scale depression domain (HADS‐D). Methods Patients from Barcelona with a primary diagnosis of rheumatoid arthritis (RA) or spondyloarthritis (SpA) completed the MDHAQ, the PHQ‐9 (depression ≥10), and the HADS‐D (depression ≥8) measures. The MDHAQ includes 2 depression items, 1 in the patient‐friendly HAQ, scored in a 4‐point format from 0 to 3.3, and a yes/no item on a 60‐symptom checklist. Percentage agreement and kappa statistics quantified the agreement between 6 screening criteria: yes on the 60‐symptom checklist, a score of ≥1.1, a score of ≥2.2 on a 4‐point scale, and either a response of yes on the 60‐symptom checklist or scores of ≥2.2, PHQ‐9 ≥10, and HADS‐D ≥8. Results Depression screening was positive according to 6 criteria in 19.6–32.4% of 102 patients with RA, and 27.9–44.8% of 68 with SpA (total = 170). All MDHAQ scores, including depression items, were higher in patients with SpA compared to patients with RA, and within each diagnostic group in patients who met PHQ‐9 ≥10 and HADS‐D ≥8 depression screening criteria. The highest percentage agreement between an MDHAQ screening criterion versus PHQ‐9 ≥10 was 83.3% for either an answer of yes on the 60‐symptom checklist or a score of ≥2.2 on a 4‐point scale, which we have termed MDHAQ‐Dep. The agreement of MDHAQ‐Dep versus HADS‐D ≥8 was 81.7%, similar to the agreement of PHQ‐9 ≥10 versus HADS‐D ≥8, which was 82.2%. Kappa measures of agreement were 0.63 for MDHAQ‐Dep versus PHQ‐9 ≥10, 0.60 for MDHAQ‐Dep versus HADS‐D ≥8, and 0.62 for PHQ‐9 ≥10 versus HADS‐D ≥8. Conclusion A positive MDHAQ‐Dep response (either an answer of yes on a 60‐symptom checklist or a score of ≥2.2 on a 4‐point scale) yielded similar results to PHQ‐9 ≥10 or HADS‐D ≥8 to screen for depression in these RA and SpA patients.