Clinical Rheumatology

, Volume 29, Issue 11, pp 1277–1283 | Cite as

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

  • John Axford
  • Alexander Butt
  • Christine Heron
  • John Hammond
  • John Morgan
  • Azita Alavi
  • Jim Bolton
  • Martin Bland
Original Article

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.

Keywords

Anxiety Depression Disability Osteoarthritis Pain 

Notes

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.

Disclosures

None

References

  1. 1.
    Axford J, O'Callaghan C (2004) Medicine, 2nd edn. Blackwell Publishing, OxfordGoogle Scholar
  2. 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 24:358–364CrossRefPubMedGoogle Scholar
  3. 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 64:461–467CrossRefPubMedGoogle Scholar
  4. 4.
    Gameroff MJ, Olfson M (2006) Major depressive disorder, somatic pain, and health care costs in an urban primary care practice. J Clin Psychiatry 67:1232–1239CrossRefPubMedGoogle Scholar
  5. 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 3:12CrossRefPubMedGoogle Scholar
  6. 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 151:979–986PubMedGoogle Scholar
  7. 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 278:1186–1190CrossRefPubMedGoogle Scholar
  8. 8.
    Macdonald AJ (1997) ABC of mental health. Mental health in old age. BMJ 315:413–417PubMedGoogle Scholar
  9. 9.
    Spigset O, Martensson B (1999) Fortnightly review: drug treatment of depression. BMJ 318:1188–1191PubMedGoogle Scholar
  10. 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 5:101CrossRefPubMedGoogle Scholar
  11. 11.
    Patten SB, Williams JV, Wang J (2006) Mental disorders in a population sample with musculoskeletal disorders. BMC Musculoskelet Disord 7:37CrossRefPubMedGoogle Scholar
  12. 12.
    Pincus T, Griffith J, Pearce S, Isenberg D (1996) Prevalence of self-reported depression in patients with rheumatoid arthritis. Br J Rheumatol 35:879–883CrossRefPubMedGoogle Scholar
  13. 13.
    Wittchen HU (2002) Generalized anxiety disorder: prevalence, burden, and cost to society. Depress Anxiety 16:162–171CrossRefPubMedGoogle Scholar
  14. 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 63:703–708CrossRefPubMedGoogle Scholar
  15. 15.
    Caracciolo B, Giaquinto S (2005) Self-perceived distress and self-perceived functional recovery after recent total hip and knee arthroplasty. Arch Gerontol Geriatr 41:177–181CrossRefPubMedGoogle Scholar
  16. 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 4:3CrossRefPubMedGoogle Scholar
  17. 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 15:1833–1840PubMedGoogle Scholar
  18. 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 52:69–77CrossRefPubMedGoogle Scholar
  19. 19.
    Melzack R (1975) The McGill Pain Questionnaire: major properties and scoring methods. Pain 1:277–299CrossRefPubMedGoogle Scholar
  20. 20.
    Charlton JE (2005) Pain measurement in humans. In: Core curriculum for professional education in pain, 3rd edn. IASP Press, SeattleGoogle Scholar
  21. 21.
    Endicott J (1984) Measurement of depression in patients with cancer. Cancer 53:2243–2249PubMedGoogle Scholar
  22. 22.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502CrossRefPubMedGoogle Scholar
  23. 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 57:415–422CrossRefPubMedGoogle Scholar
  24. 24.
    Lad M (2006) Regional competitiveness and state of the regions. National Statistics BERR Publications. July, 17–23Google Scholar
  25. 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 64:461–560CrossRefGoogle Scholar
  26. 26.
    Edwards RR, Bingham CO 3rd, Bathon J, Haythornthwaite JA (2006) Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis Rheum 55:325–332CrossRefPubMedGoogle Scholar
  27. 27.
    Siedlecki SL (2006) Predictors of self-rated health in patients with chronic nonmalignant pain. Pain Manag Nurs 7:109–116CrossRefPubMedGoogle Scholar
  28. 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 319:1235–1243CrossRefPubMedGoogle Scholar
  29. 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 2:31CrossRefGoogle Scholar
  30. 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) 38:959–967CrossRefGoogle Scholar
  31. 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 47:291–302CrossRefPubMedGoogle Scholar
  32. 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) 42:435–441CrossRefGoogle Scholar
  33. 33.
    Calfas KJ, Kaplan RM, Ingram RE (1992) One-year evaluation of cognitive-behavioral intervention in osteoarthritis. Arthritis Care Res 5:202–209CrossRefPubMedGoogle Scholar
  34. 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 290:2428–2429CrossRefPubMedGoogle Scholar
  35. 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 25:1484–1492CrossRefPubMedGoogle Scholar
  36. 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 331:69–73CrossRefPubMedGoogle Scholar
  37. 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 31:204–209CrossRefPubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 2010

Authors and Affiliations

  • John Axford
    • 1
  • Alexander Butt
    • 2
  • Christine Heron
    • 3
  • John Hammond
    • 4
  • John Morgan
    • 5
  • Azita Alavi
    • 1
  • Jim Bolton
    • 6
  • Martin Bland
    • 7
  1. 1.The Sir Joseph Hotung Centre for Musculoskeletal Disorders, Department of Cellular Molecular MedicineSt George’s University of LondonLondonUK
  2. 2.Department of Adult PsychiatrySpringfield University HospitalLondonUK
  3. 3.Department of RadiologySt George’s HospitalLondonUK
  4. 4.School of PhysiotherapyKingston UniversitySurreyUK
  5. 5.Department of PsychiatrySt George’s HospitalLondonUK
  6. 6.Department of PsychiatrySt Helier HospitalLondonUK
  7. 7.Health StatisticsUniversity of YorkYorkUK

Personalised recommendations