BackgroundWhile it is recognised that depression is prevalent in Rheumatoid Arthritis (RA), recent studies have also highlighted significant levels of anxiety in RA patients. This study compared two commonly used scales, the Depression Anxiety and Stress Scale (DASS) and the Hospital Anxiety and Depression Scale (HADS), in relation to their measurement range and cut points to consider the relative prevalence of both constructs, and if prevalence rates may be due to scale-specific case definition.MethodsPatients meeting the criteria for RA were recruited in Leeds, UK and Sydney, Australia and asked to complete a survey that included both scales. The data was analysed using the Rasch measurement model.ResultsA total of 169 RA patients were assessed, with a repeat subsample, resulting in 323 cases for analysis. Both scales met Rasch model expectations. Using the 'possible+probable' cut point from the HADS, 58.3% had neither anxiety nor depression; 13.5% had anxiety only; 6.4% depression only and 21.8% had both 'possible+probable' anxiety and depression. Cut points for depression were comparable across the two scales while a lower cut point for anxiety in the DASS was required to equate prevalence.ConclusionsThis study provides further support for high prevalence of depression and anxiety in RA. It also shows that while these two scales provide a good indication of possible depression and anxiety, the estimates of prevalence so derived could vary, particularly for anxiety. These findings are discussed in terms of comparisons across studies and selection of scales for clinical use.

Despite substantial advances in other areas of forgiveness research, empirical evaluation of a fundamental aspect of forgiveness, the process itself, has been virtually nonexistent. This article reviews the existing literature and concludes that although numerous process models have been proposed, many lack a coherent theoretical grounding, and few have been empirically validated. Importantly, understanding of the forgiveness process is hindered by a lack of consensus on what forgiveness is, and consequently what constitutes the endpoint of the process. In response to the many shortcomings in the literature, salient issues for future research are identified. The stress and coping model (Lazarus & Folkman, 1984) is proposed as a framework for guiding theorizing and research.Empirical psychological research on forgiveness has increased dramatically over the past two decades. Having long been considered the domain of theology and philosophy, the psychological antecedents, properties, and consequences of forgiveness now have been studied in a variety of settings-e.g., counseling, social, justice, organizational, and cultural-with adolescents and adults, couples, families, and groups, and as a response to a wide range of hurts and injustices. Forgiveness research has been extended beyond its traditional focus on forgiveness of others to include forgiveness of self

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These results suggest that physical disability, helplessness and passive coping have a significant impact on the levels of pain and depression experienced by RA patients.