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Validation of Standardized Questionnaires Evaluating Symptoms of Depression in Rheumatoid Arthritis Patients: Approaches to Screening for a Frequent Yet Underrated Challenge
Author(s) -
Englbrecht Matthias,
Alten Rieke,
Aringer Martin,
Baerwald Christoph G.,
Burkhardt Harald,
Eby Nancy,
Fliedner Gerhard,
Gauger Bettina,
Henkemeier Ulf,
Hofmann Michael W.,
Kleinert Stefan,
Kneitz Christian,
Krueger Klaus,
Pohl Christoph,
Roske AnneEve,
Schett Georg,
Schmalzing Marc,
Tausche AnneKathrin,
Peter Tony Hans,
Wendler Joerg
Publication year - 2017
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23002
Subject(s) - discriminant validity , convergent validity , gold standard (test) , beck depression inventory , depression (economics) , criterion validity , physical therapy , construct validity , medicine , patient health questionnaire , clinical psychology , rheumatoid arthritis , rating scale , psychology , psychometrics , psychiatry , depressive symptoms , anxiety , developmental psychology , economics , internal consistency , macroeconomics
Objective To validate standard self‐report questionnaires for depression screening in patients with rheumatoid arthritis (RA) and compare these measures to one another and to the Montgomery‐Åsberg Depression Rating Scale (MADRS), a standardized structured interview. Methods In 9 clinical centers across Germany, depressive symptomatology was assessed in 262 adult RA patients at baseline (T0) and at 12 ± 2 weeks followup (T1) using the World Health Organization 5‐Item Well‐Being Index (WHO‐5), the Patient Health Questionnaire (PHQ‐9), and the Beck Depression Inventory II (BDI‐II). The construct validity of these depression questionnaires (using convergent and discriminant validity) was evaluated using Spearman's correlations at both time points. The test–retest reliability of the questionnaires was evaluated in RA patients who had not undergone a psychotherapeutic intervention or received antidepressants between T0 and T1. The sensitivity and the specificity of the questionnaires were calculated using the results of the MADRS, a structured interview, as the gold standard. Results According to Spearman's correlation coefficients, all questionnaires met convergent validity criteria (ρ > |0.50|), with the BDI‐II performing best, while correlations with age and disease activity for all questionnaires met the criteria for discriminant validity (ρ < |0.50|). The only questionnaire to meet the predefined retest reliability criterion (ρ ≥ 0.70) was the BDI‐II (r s = 0.77), which also achieved the best results for both sensitivity and specificity (>80%) when using the MADRS as the gold standard. Conclusion The BDI‐II best met the predefined criteria, and the PHQ‐9 met most of the validity criteria, with lower sensitivity and specificity.