The detection of psychiatric morbidity and associated factors in patients with rheumatoid arthritis

Eighty-six patients with a confirmed diagnosis of rheumatoid arthritis were surveyed to assess the extent of psychiatric morbidity as indicated by two screening questionnaires, the General Health Questionnaire and the Hospital Anxiety and Depression Scale. In addition to an investigation of the concordance of the screening questionnaires, a description of demographic characteristics and measures of disability were taken. Disability due to arthritis was indicated by measures of years of chronicity, pain, duration of morning stiffness, functional level, active treatment involvement, and presence of coexisting medical problems. The relationship of physical symptoms to level of psychiatric distress was investigated. Psychiatric cases were identified using recommended cut off scores on results of the screening questionnaires. GHQ cut off scores of 6/7 identified as "cases" 31.8% of the sample. HADS subscale cut off scores of 8/9 identified 21.4% of subjects with "anxiety" and 19.0% with "depression" scores in the morbid range. Nineteen percent of patients were found to have scores on both tests concurrently in the pathological range.