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Prevalence of anxiety and depression in osteoarthritis: use of the Hospital Anxiety and Depression Scale as a screening tool

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Abstract

The aims of this study are to ascertain the prevalence of anxiety and depressive disorders in an outpatient population with osteoarthritis (OA), examine the interrelationships between severity of OA, pain, disability, and depression, and evaluate the Hospital Anxiety and Depression Scale (HADS) as a screening tool for this population. Patients with lower limb OA were evaluated with the Short Form McGill Pain and Present Pain Index Questionnaires, and a visual analogue scale, WOMAC Osteoarthritis Index-section C, and the HADS. Participants underwent a structured clinical interview by a liaison psychiatrist (AB). X-rays of affected joints were rated for disease severity. Fifty-four patients (42 females; mean age 63.3) were investigated. The prevalence of clinically significant anxiety and/or depression was 40.7% (95% confidence interval (CI), 27.6–55.0%). HADS was a good predictor of anxiety and depression with a sensitivity and specificity of 88% (95%CI, 64% to 99%) and 81% (95%CI, 65% to 92%), respectively. Pain correlated with HADS anxiety and depression scores (e.g. Rank correlation coefficients (Kendall’s tau-b) between total HADS scores and Pain VAS scores 0.29; p = 0.003). Disability was greater in patients with depression and/or anxiety (e.g. total HADS score; Kendall’s rank correlation coefficient tau-b = 0.26, p = 0.007) OA severity as determined by radiological score was not a good predictor for anxiety nor depression and only weakly associated with disability. Anxiety and depression are very common in OA patients. HADS anxiety was a better predictor of diagnosed anxiety than HADS depression was of diagnosed depression. HADS is a valid and reliable screening instrument for detecting mood disorder, but not a diagnostic tool or a substitute for asking about symptoms of depression. The interrelationship between mental health, pain and disability is strong. We should therefore adopt a multidisciplinary approach to the management of OA.

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References

  1. Axford J, O'Callaghan C (2004) Medicine, 2nd edn. Blackwell Publishing, Oxford

    Google Scholar 

  2. Victor CR, Triggs E, Ross F, Lord J, Axford JS (2005) Lack of benefit of a primary care-based nurse-led education programme for people with osteoarthritis of the knee. Clin Rheumatol 24:358–364

    Article  PubMed  Google Scholar 

  3. Axford J, Heron C, Ross F, Victor CR (2008) Management of knee osteoarthritis in primary care: pain and depression are the major obstacles. J Psychosom Res 64:461–467

    Article  PubMed  Google Scholar 

  4. Gameroff MJ, Olfson M (2006) Major depressive disorder, somatic pain, and health care costs in an urban primary care practice. J Clin Psychiatry 67:1232–1239

    Article  PubMed  Google Scholar 

  5. Nour K, Laforest S, Gauvin L, Gignac M (2006) Behavior change following a self-management intervention for housebound older adults with arthritis: an experimental study. Int J Behav Nutr Phys Act 3:12

    Article  PubMed  Google Scholar 

  6. Blazer DG, Kessler RC, McGonagle KA, Swartz MS (1994) The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry 151:979–986

    CAS  PubMed  Google Scholar 

  7. Lebowitz BD, Pearson JL, Schneider LS, Reynolds CF 3rd, Alexopoulos GS, Bruce ML, Conwell Y, Katz IR, Meyers BS, Morrison MF, Mossey J, Niederehe G, Parmelee P (1997) Diagnosis and treatment of depression in late life. Consensus statement update. Jama 278:1186–1190

    Article  CAS  PubMed  Google Scholar 

  8. Macdonald AJ (1997) ABC of mental health. Mental health in old age. BMJ 315:413–417

    CAS  PubMed  Google Scholar 

  9. Spigset O, Martensson B (1999) Fortnightly review: drug treatment of depression. BMJ 318:1188–1191

    CAS  PubMed  Google Scholar 

  10. Gensichen J, Torge M, Peitz M, Wendt-Hermainski H, Beyer M, Rosemann T, Krauth C, Raspe H, Aldenhoff JB, Gerlach FM (2005) Case management for the treatment of patients with major depression in general practices—rationale, design and conduct of a cluster randomized controlled trial—PRoMPT (PRimary care Monitoring for depressive Patient's Trial) [ISRCTN66386086]—study protocol. BMC Public Health 5:101

    Article  PubMed  Google Scholar 

  11. Patten SB, Williams JV, Wang J (2006) Mental disorders in a population sample with musculoskeletal disorders. BMC Musculoskelet Disord 7:37

    Article  PubMed  Google Scholar 

  12. Pincus T, Griffith J, Pearce S, Isenberg D (1996) Prevalence of self-reported depression in patients with rheumatoid arthritis. Br J Rheumatol 35:879–883

    Article  CAS  PubMed  Google Scholar 

  13. Wittchen HU (2002) Generalized anxiety disorder: prevalence, burden, and cost to society. Depress Anxiety 16:162–171

    Article  PubMed  Google Scholar 

  14. Ravaud P, Giraudeau B, Logeart I, Larguier JS, Rolland D, Treves R, Euller-Ziegler L, Bannwarth B, Dougados M (2004) Management of osteoarthritis (OA) with an unsupervised home based exercise programme and/or patient administered assessment tools. A cluster randomised controlled trial with a 2×2 factorial design. Ann Rheum Dis 63:703–708

    Article  CAS  PubMed  Google Scholar 

  15. Caracciolo B, Giaquinto S (2005) Self-perceived distress and self-perceived functional recovery after recent total hip and knee arthroplasty. Arch Gerontol Geriatr 41:177–181

    Article  CAS  PubMed  Google Scholar 

  16. Hirvonen J, Blom M, Tuominen U, Seitsalo S, Lehto M, Paavolainen P, Hietaniemi K, Rissanen P, Sintonen H (2006) Health-related quality of life in patients waiting for major joint replacement. A comparison between patients and population controls. Health Qual Life Outcomes 4:3

    Article  PubMed  Google Scholar 

  17. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840

    CAS  PubMed  Google Scholar 

  18. Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 52:69–77

    Article  PubMed  Google Scholar 

  19. Melzack R (1975) The McGill Pain Questionnaire: major properties and scoring methods. Pain 1:277–299

    Article  CAS  PubMed  Google Scholar 

  20. Charlton JE (2005) Pain measurement in humans. In: Core curriculum for professional education in pain, 3rd edn. IASP Press, Seattle

  21. Endicott J (1984) Measurement of depression in patients with cancer. Cancer 53:2243–2249

    CAS  PubMed  Google Scholar 

  22. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502

    Article  CAS  PubMed  Google Scholar 

  23. Rosemann T, Backenstrass M, Joest K, Rosemann A, Szecsenyi J, Laux G (2007) Predictors of depression in a sample of 1, 021 primary care patients with osteoarthritis. Arthritis Rheum 57:415–422

    Article  PubMed  Google Scholar 

  24. Lad M (2006) Regional competitiveness and state of the regions. National Statistics BERR Publications. July, 17–23

  25. Axford J, Heron C, Ross F, Victor C (2008) Management of knee osteoarthritis in primary care: pain and depression are the major obstacles. J Psycho Res 64:461–560

    Article  Google Scholar 

  26. Edwards RR, Bingham CO 3rd, Bathon J, Haythornthwaite JA (2006) Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis Rheum 55:325–332

    Article  PubMed  Google Scholar 

  27. Siedlecki SL (2006) Predictors of self-rated health in patients with chronic nonmalignant pain. Pain Manag Nurs 7:109–116

    Article  PubMed  Google Scholar 

  28. Duric V, McCarson KE (2006) Effects of analgesic or antidepressant drugs on pain- or stress-evoked hippocampal and spinal neurokinin-1 (NK-1) receptor and brain-derived neurotrophic factor (BDNF) gene expression in the rat. J Pharmacol Exp Ther 319:1235–1243

    Article  CAS  PubMed  Google Scholar 

  29. Marazziti D, Mungai F, Vivarelli L, Presta S, Dell'osso B (2006) Pain and psychiatry: a critical analysis and pharmacological review. Clin Pract Epidemol Ment Health 2:31

    Article  Google Scholar 

  30. Ash G, Dickens CM, Creed FH, Jayson MI, Tomenson B (1999) The effects of dothiepin on subjects with rheumatoid arthritis and depression. Rheumatology (Oxford) 38:959–967

    Article  CAS  Google Scholar 

  31. Astin JA, Beckner W, Soeken K, Hochberg MC, Berman B (2002) Psychological interventions for rheumatoid arthritis: a meta-analysis of randomized controlled trials. Arthritis Rheum 47:291–302

    Article  PubMed  Google Scholar 

  32. Sharpe L, Sensky T, Timberlake N, Ryan B, Allard S (2003) Long-term efficacy of a cognitive behavioural treatment from a randomized controlled trial for patients recently diagnosed with rheumatoid arthritis. Rheumatology (Oxford) 42:435–441

    Article  CAS  Google Scholar 

  33. Calfas KJ, Kaplan RM, Ingram RE (1992) One-year evaluation of cognitive-behavioral intervention in osteoarthritis. Arthritis Care Res 5:202–209

    Article  CAS  PubMed  Google Scholar 

  34. Lin EH, Katon W, Von Korff M, Tang L, Williams JW Jr, Kroenke K, Hunkeler E, Harpole L, Hegel M, Arean P, Hoffing M, Della Penna R, Langston C, Unutzer J (2003) Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial. JAMA 290:2428–2429

    Article  CAS  PubMed  Google Scholar 

  35. Boos N, Semmer N, Elfering A, Schade V, Gal I, Zanetti M, Kissling R, Buchegger N, Hodler J, Main CJ (2000) Natural history of individuals with asymptomatic disc abnormalities in magnetic resonance imaging: predictors of low back pain-related medical consultation and work incapacity. Spine 25:1484–1492

    Article  CAS  PubMed  Google Scholar 

  36. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS (1994) Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 331:69–73

    Article  CAS  PubMed  Google Scholar 

  37. Summers MN, Haley WE, Reveille JD, Alarcon GS (1988) Radiographic assessment and psychologic variables as predictors of pain and functional impairment in osteoarthritis of the knee or hip. Arthritis Rheum 31:204–209

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

Dr Marcus Hughes is thanked for the critical review of the manuscript, Sarah White for help with the statistics and Caroline Cooper for coordinating the manuscript.

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Authors and Affiliations

  1. The Sir Joseph Hotung Centre for Musculoskeletal Disorders, Department of Cellular Molecular Medicine, St George’s University of London, London, SW17 OQT, UK

    John Axford & Azita Alavi

  2. Department of Adult Psychiatry, Springfield University Hospital, London, UK

    Alexander Butt

  3. Department of Radiology, St George’s Hospital, London, UK

    Christine Heron

  4. School of Physiotherapy, Kingston University, Surrey, UK

    John Hammond

  5. Department of Psychiatry, St George’s Hospital, London, UK

    John Morgan

  6. Department of Psychiatry, St Helier Hospital, London, UK

    Jim Bolton

  7. Health Statistics, University of York, York, UK

    Martin Bland

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  1. John Axford
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  2. Alexander Butt
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  3. Christine Heron
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  4. John Hammond
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  5. John Morgan
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  6. Azita Alavi
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  7. Jim Bolton
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Correspondence to John Axford.

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Axford, J., Butt, A., Heron, C. et al. Prevalence of anxiety and depression in osteoarthritis: use of the Hospital Anxiety and Depression Scale as a screening tool. Clin Rheumatol 29, 1277–1283 (2010). https://doi.org/10.1007/s10067-010-1547-7

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  • DOI: https://doi.org/10.1007/s10067-010-1547-7

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