Australian researchers report on a simple tool that can alert rheumatologists to potential mental health comorbidities in patients.
The Multidimensional Health Assessment Questionnaire (MDHAQ) can successfully screen for anxiety in patients with rheumatoid arthritis and psoriatic arthritis, Australian researchers have found.
The MDHAQ is routinely used to collect patient-reported outcome measures in rheumatology care and includes two items relating to anxiety.
The researchers compared patients’ scores for these items with scores on the more-comprehensive Hospital Anxiety and Depression Scale subscale for Anxiety (HADS-A) and found “substantial agreement” between the two, they reported in The Journal of Rheumatology.
“Screening tools such as the MDHAQ are required to improve our communication with patients in a time-efficient way,” said first author Dr Sadia Islam, a rheumatologist at Liverpool Hospital in Sydney.
“Mental health is rarely screened for in practice, but we know the impact it has on health outcomes for our patients,” Dr Islam told Rheumatology Republic.
“This is a simple tool that can alert and prompt rheumatologists to explore potential psychological comorbidities, and also provides patients with an opportunity to raise these concerns.”
Compared with the general population, anxiety is relatively common in these patient groups, affecting an estimated 21-70% of RA patients and 15-30% of PsA patients.
The authors noted that anxiety is associated with higher scores on patient-reported outcome measures, such as the RAPID3, and can lead to overestimation and overtreatment of inflammatory disease activity. As such, it’s important to identify patients who may need further evaluation and management of anxiety.
The MDHAQ has previously demonstrated utility in screening for depression in these patient groups. Prior to the current study, however, its reliability in screening for anxiety hadn’t been examined.
Over 180 patients attending the rheumatology outpatient clinic at Liverpool Hospital were included in the study: 126 with RA (mean age around 60 and mostly female) and 57 with PsA (mean age 52 and mostly men).
Around 40% screened positive for anxiety on the HADS-A, with a score of ≥8, while 35% had a positive screen for anxiety based on a composite score of ≥2.2 or a ‘yes’ to anxiety on the MDHAQ range of symptoms component.
An MDHAQ score of ≥2.2 or positive on the ROS provided 69.9% sensitivity and 88.2% specificity for screening for anxiety, with 80.9% agreement (κ 0.59), the authors reported.
They also found that a positive screen for anxiety was correlated with higher scores on patient-reported outcome measures.
Patients who screened positive for anxiety had mean scores on the RAPID3 in the high disease severity category, while patients who screened negative to anxiety had mean RAPID3 scores in the moderate disease severity category – yet there was no difference in inflammatory markers between the two groups.
“To our knowledge, our study is the first to examine the criterion validity of the MDHAQ in screening for anxiety in patients with inflammatory disorders,” the authors wrote.
“The MDHAQ includes a number of useful scales for clinical assessment during routine care, including the RAPID3, RADAI, and FAST4.
“Our study presents an additional tool within the MDHAQ for multidimensional clinical assessment through the use of a single questionnaire that encompasses both psychological screening and measures of disease activity.”
