Assessment of the Hospital Anxiety and Depression Scale (HADS) performance for the diagnosis of anxiety in patients with systemic lupus erythematosus
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Neuropsychiatric lupus (NPSLE) is described in 12–95% of patients with systemic lupus erythematosus (SLE). Anxiety disorders are among the most frequent manifestations of NPSLE, occurring in 4–85% of these patients. Several diagnostic tools, such as Hospital Anxiety and Depression Scale (HADS), have been used to assess anxiety in clinical studies in SLE, but there is a lack of data on the performance of these questionnaires in the disease. This study aimed to assess the performance of HADS for the detection of anxiety in male and female patients with SLE, also investigating possible gender differences in this aspect. This study included 54 male SLE patients and 54 female SLE patients. The Diagnostic Criteria for Generalized Anxiety Disorder of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders was used as gold-standard method to assess the performance of HADS for detecting anxiety in SLE patients. HADS presented sensitivity of 88.9% and specificity of 92.6%, with positive and negative predictive values of 80.0 and 96.1%, respectively. The HADS accuracy in total sample was 92.6%, with Kappa coefficient equal to 0.5794 (95% CI 0.3894–0.7695). No significant differences were observed between female and male groups regarding the performance of HADS for diagnosing anxiety.
KeywordsSystemic lupus erythematosus Anxiety Hospital Anxiety and Depression Scale
Compliance with ethical standards
Conflict of interest
Eduardo de Almeida Macêdo: the author declares that he has no conflict of interest. Simone Appenzeller: the author declares that she has no conflict of interest. Lilian Tereza Lavras Costallat: the author declares that she has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.Wallace DJ, Hahn BH (2013) Dubois lupus erythematosus and related syndromes, 8th edn. Elsevier, PhiladelphiaGoogle Scholar
- 5.Pamfil C, Fanouriakis A, Damian L, Rinzis M, Sidiropoulos P, Tsivgoulis G, Rednic S, Bertsias G, Boumpas DT (2015) EULAR recommendations for neuropsychiatric systemic lupus erythematosus vs usual care: results from two European centres. Rheumatology 54(7):1270–1278. doi: 10.1093/rheumatology/keu482 CrossRefPubMedGoogle Scholar
- 6.ACR Ad Hoc Committee of Neuropsychiatric Lupus Nomenclature (1999) The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 42(4):599–608. doi: 10.1002/1529-0131(199904)42:4<599::AID-ANR2>3.0.CO;2-F CrossRefGoogle Scholar
- 12.Shen B, Tan W, Feng G, He Y, Liu J, Chen W, Huang X, Da Z, Xu X, Liu H, Gu Z (2013) The correlations of disease activity, socioeconomic status, quality of life, and depression/anxiety in Chinese patients with systemic lupus erythematosus. Clin Dev Immunol 2013:270878. doi: 10.1155/2013/270878 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40(9):1725. doi: 10.1002/1529-0131(199709)40:9<1725:AID-ART29>3.0.CO;2-Y CrossRefPubMedGoogle Scholar
- 18.Associação Brasileira de Empresas de Pesquisa-ABEP (2014) Critério de Classificação Econômica Brasil. http://www.abep.org/criterio-brasil. Accessed 02 Jan 2014
- 20.Petri M, Kim MY, Kalunian KC, Grossman J, Hahn BH, Sammaritano LR, Lockshin M, Merrill JT, Belmont HM, Askanase AD, McCune WJ, Hearth-Holmes M, Dooley MA, Von Feldt J, Friedman A, Tan M, Davis J, Cronin M, Diamond B, Mackay M, Sigler L, Fillius M, Rupel A, Licciardi F, Buyon JP, Trial O-S (2005) Combined oral contraceptives in women with systemic lupus erythematosus. N Engl J Med 353(24):2550–2558. doi: 10.1056/NEJMoa051135 CrossRefPubMedGoogle Scholar
- 21.Gladman D, Ginzler E, Goldsmith C, Fortin P, Liang M, Urowitz M, Bacon P, Bombardieri S, Hanly J, Hay E, Isenberg D, Jones J, Kalunian K, Maddison P, Nived O, Petri M, Richter M, Sanchez-Guerrero J, Snaith M, Sturfelt G, Symmons D, Zoma A (1996) The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum 39(3):363–369CrossRefPubMedGoogle Scholar
- 22.Fleiss JL (1981) Statistical methods for rates and proportions, 2nd edn. Wiley, New YorkGoogle Scholar
- 24.Statistical Analysis System Institute Inc (2013) SAS 9.4 Procedures Guide. SAS Institute Inc, Cary, NCGoogle Scholar
- 27.Firestein GS, Budd RC, Gabriel SE, McInnes IB, O’Dell JR (2013) Kelley’s textbook of rheumatology, vol II, 9th edn. Elsevier, PhiladelphiaGoogle Scholar
- 28.Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH (2015) Rheumatology, vol II, 6th edn. Elsevier, PhiladelphiaGoogle Scholar