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

Abstract

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.

HAQ and DAS28 for clinical trials over months and MDHAQ, RheuMetric and psycho-socio-economic measures for long-term observations over years?

“…FAST4 (fibromyalgia assessment screening tool) agrees 90% with revised 2011 fibromyalgia criteria [ 6 ] to screen for fibromyalgia. MDS2 (MDHAQ depression screen) agrees 80% with two reference depression screening questionnaires, PHQ9 and HADS-D, similar to agreement of the two reference questionnaires with one another [ 7 ] to screen for depression. Comorbid fibromyalgia and/or depression are seen in 25–45% of people with RA [ 2 ]; they are easily diagnosed in some patients, but often underrecognized or unrecognized.…”

Should Quantitative Measures and Management of Rheumatoid Arthritis Include More Than Control of Inflammatory Activity?

“…Patient distress also may be screened for quantitatively, using 2 indices within the Multidimensional Health Assessment Questionnaire (MDHAQ) beyond RAPID3: the FAST4 (Fibromyalgia Assessment Screening Tool 4) 9 and DEP2 (depression). 5 These indices agree > 80% with formal 2011 FM criteria 9 and reference PHQ-9 and HADS-D questionnaires (similar to the level of agreement of PHQ-9 with HADS-D), 5 without an additional questionnaire such as the 2011 FM criteria, PHQ-9, HADS, or other 1-page questionnaire, and can be helpful to clarify patient global assessment.…”

“…Even agreement between 2 major reference depression screening questionnaires, the Patient Health Questionnaire-9 (PHQ-9) and Hospital Anxiety and Depression Scale Depression subscale (HADS-D), was 82%. 5 Many "disparities" result from conversion of continuous to categorical variables; if disparities were large, correlations between CDAI vs RAPID3 could not be > 0.72 in 2 databases and 0.58 in the third (Table 1).…”

RheuMetric Quantitative 0 to 10 Physician Estimates of Inflammation, Damage, and Distress in Rheumatoid Arthritis: Validation Against Reference Measures

“…Fibromyalgia assessment screening tool (FAST4) (28,29) is a cumulative index to screen for fibromyalgia based on four variables, with one point each for pain VNS greater than or equal to 6/10, fatigue VNS greater than or equal to 6/10, self-report RADAI joint count greater than or equal to 16/54, and 60-symptom checklist greater than or equal to 16/60; three of four components yield a positive fibromyalgia screen, which agrees 90% with the 2011 revised fibromyalgia criteria (30). MDS2, a cumulative index reported initially as MDHAQ-Dep (31) based on two MDHAQ responses, agrees 81.7% to 83.3% with reference patient health questionnaire 9 (PHQ-9) (32) and hospital anxiety and depression scale-depression (HADS-D) (33), virtually identical to the 82.2% agreement of the two reference questionnaires with one another (31).…”