Depression assessment in Rheumatoid Arthritis patients in Rheumatoloay clinic in Connolly Hospital
Al Ghafri Aadil1, Hussain Omar1, , Duffy Trevor1, Murphy Ethene1, Barry Maurice1
1Department of Rheumatology, Connolly Hospital, Dublin, Ireland
Rheumatoid arthritis (RA) is a systemic, chronic, and inflammatory disease causes many harmful psychosocial consequences for patients. Continuous pain, functional disability, tiredness, incapacity to work, economic limitations, and side effects of therapeutic drugs, which RA may bring about, can end up reducing these patients’ quality of life. Commonly associated with these biopsychosocial problems, psychiatric symptoms -especially depressive and anxiety ones- are relatively frequent in RA patients. Several studies have identified depressive symptoms as an important aspect in RA. The prevalence of depressive symptoms in RA has been reported to vary between 6% and 65%, according to the screening methods used and to the samples studied.
To determine the frequency of depressive and anxiety symptoms in patients with rheumatoid arthritis (RA) (a chronic inflammatory disease) and to evaluate rheumatologist adherence to depression and anxiety assessment and management in comparison to a control group with Diabetes Mellitus (DM) (a chronic non-inflammatory disease).
60 RA patients and another 60 DM patients participated in the study. The Hospital Anxiety and Depression Scale (HADS) was applied.
Among 60 RA patients, 51(85.0%) had a normal depression score. 4(6.7%) were borderline and 5(83%) had an abnormal score. Regarding anxiety, 37(61.7%) had a normal score, 16(26.7%) were borderline and 7(11.7%) had an abnormal score. When deptession and anxiety scores were combined, 35(58%) patients were normal, 3(5%) patients had abnormal score with 22(37%) of 60 patients either borderline or abnormal for anxiety/ depression. Of 60 RA patients, only 7(11.7%) patients had had formal assessment for depression and anxiety at the rheumatology clinic. 53(883%) did not receive any assessment. Of the 7 patients who received depression and anxiety assessment, only 1(13%) received it in rheumatology clinic, while the remainder were assessed by their GP. Of the patients treated, 9 received medication, while only 1(1.7%) received a combination of medications and cognitive behavioural therapy (CBT).
Of the 60 DM patients, 47(78.4%) had a normal depression score, 5(8.3%) were borderline and 8(13.1%) were normal. 49(81.6%) had a normal anxiety score, 8(13.4%) were borderline and 3(5%) abnormal. Combining depression and anxiety scores, results were both normal in 28(46.6%) patients, both abnormal in 27 (45%) patients and borderline in 5(8.3%) patients. Out of 60 DM patients, only 18(30%) patients were formally assessed for depressive and anxiety symptoms, whilst 42(70%) didn't receive any assessment.
Of the 18 patients who received deptession and anxiety assessment, only 2(3.3%) received it in the endocrine clinic, while the remainder 16(26.6%) were carried out by their GPs. Of patients treated, 9(15%) received medications, while only 6(10%) received combination of medications and CBT.
This audit provides similar data for high frequency of depression and anxiety among RA patients. In addition, it shows under-assessment and under-treated depressive and anxiety symptoms in RA patients. Patient at risk should be screened and managed by medication, CBT, or both.