Assessment of the psychometric properties of patient-reported outcomes of depression and anxiety in systemic lupus erythematosus

Semin Arthritis Rheum. 2019 Oct;49(2):260-266. doi: 10.1016/j.semarthrit.2019.03.004. Epub 2019 Mar 9.

Abstract

Objectives: This study aimed to: 1) determine the prevalence of depression and anxiety in SLE patients using the Center for Epidemiological Studies-Depression Scale [CES-D], Hospital Anxiety and Depression Scale [HADS], and Beck Anxiety Inventory [BAI] questionnaires; 2) study the criterion validity, interpretability, and test-retest reliability of CES-D, HADS and BAI; and 3) evaluate their diagnostic accuracy when compared to the assessment of an independent psychiatric assessment using the Mini-International Neuropsychiatric Interview (MINI).

Methods: 159 consecutive SLE participants were screened for depression and anxiety using the CES-D, HADS, and BAI, and underwent the MINI. Sensitivity and specificity were evaluated against the MINI. Test-retest reliability was studied. Receiver operator characteristic (ROC) curves were utilized to determine the cut-off scores for CES-D, HADS and BAI.

Results: The prevalence of depression ranged from 29% (HADS-D) to 52% (CES-D) and the prevalence of anxiety ranged from 45% (BAI) to 50% (HADS-A). ROC showed similar performance for CES-D and HADS-D. The diagnostic accuracy of HADS-A outperformed BAI. Furthermore, these self-reported questionnaires demonstrated good to excellent test-retest reliability. Analyses exhibited optimal cut-offs for CES-D (26), BAI (19), HADS-A (6), and HADS-D (8) that optimized their sensitivity and specificity as screening metrics for depression and anxiety in SLE patients.

Conclusions: Anxiety and depression are highly prevalent in patients with SLE. Patient-reported outcome questionnaires such as the CES-D, HADS, and BAI may be useful tools to screen for depression and anxiety in SLE. Our results suggest that SLE-specific cut-offs may improve diagnostic accuracy of current screening metrics in patients with lupus.

Keywords: Anxiety; BAI; CES-D; Depression; Patient-reported-outcomes; Systemic lupus erythematosus.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anxiety / epidemiology*
  • Comorbidity
  • Cross-Sectional Studies
  • Depression / epidemiology*
  • Female
  • Humans
  • Lupus Erythematosus, Systemic / epidemiology*
  • Male
  • Mass Screening
  • Middle Aged
  • Patient Reported Outcome Measures
  • Prevalence
  • Psychometrics
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Surveys and Questionnaires