Division of Rheumatology, Department of Medicine, School of Medicine, Showa University Tokyo, Japan
Yusuke Miwa1, Yuko Mitamura2, Hiroi Tomioka3 and Michio Hosaka4, 1Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan, 2Department of Nursing, Showa University School of Nursing and Rehabilitation Sciences, Tokyo, Japan, 3Department of Psychiatry, School of Medicine, Yokohama, Japan, 4Department of psychosomatic medicine, Fujiyoshida, 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. Most of the studies have used questionnaires for depression. Because the depression questionnaire includes questions about physical symptoms, it is necessary to be careful in interpreting the results 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 the diagnosis of RA complicated by psychiatric disorders.
Methods: Forty-nine 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 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. The psychiatrist was blinded to the results of the questionnaire 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: The psychiatrist’s diagnosis was abnormal in 11 patients. This included one patient with major depression, one patient with moderate depression, two patients with minor depression, two patients with adjustment disorder, one patient with neurosis, and one with anxiety. The PHQ-9 had a specificity of 98.2%, a sensitivity of 36.4%, a positive predictive value of 80.0%, and a negative predictive value of 88.5%. The CES-D had a specificity of 87.3%, a sensitivity of 90.9%, a positive predictive value of 58.8%, and a negative predictive value of 98.0%.
Conclusion: The PHQ-9 and CES-D may be useful in screening for psychiatric disorders including those associated with RA.
Disclosures: Y. Miwa, Pfizer; Y. Mitamura, None; H. Tomioka, None; M. Hosaka, None.
