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. 2012 Jan 24:12:6.
doi: 10.1186/1471-244X-12-6.

Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the hospital, Anxiety and Depression Scale (HADS)

Tanya Covic  1 , Steven R Cumming, Julie F Pallant, Nick Manolios, Paul Emery, Philip G Conaghan, Alan Tennant
Affiliations

Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the hospital, Anxiety and Depression Scale (HADS)

Tanya Covic et al. BMC Psychiatry. .

Abstract

Background: While it is recognised that depression is prevalent in Rheumatoid Arthritis (RA), recent studies have also highlighted significant levels of anxiety in RA patients. This study compared two commonly used scales, the Depression Anxiety and Stress Scale (DASS) and the Hospital Anxiety and Depression Scale (HADS), in relation to their measurement range and cut points to consider the relative prevalence of both constructs, and if prevalence rates may be due to scale-specific case definition.

Methods: Patients meeting the criteria for RA were recruited in Leeds, UK and Sydney, Australia and asked to complete a survey that included both scales. The data was analysed using the Rasch measurement model.

Results: A total of 169 RA patients were assessed, with a repeat subsample, resulting in 323 cases for analysis. Both scales met Rasch model expectations. Using the 'possible+probable' cut point from the HADS, 58.3% had neither anxiety nor depression; 13.5% had anxiety only; 6.4% depression only and 21.8% had both 'possible+probable' anxiety and depression. Cut points for depression were comparable across the two scales while a lower cut point for anxiety in the DASS was required to equate prevalence.

Conclusions: This study provides further support for high prevalence of depression and anxiety in RA. It also shows that while these two scales provide a good indication of possible depression and anxiety, the estimates of prevalence so derived could vary, particularly for anxiety. These findings are discussed in terms of comparisons across studies and selection of scales for clinical use.

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Figures

Figure 1
Figure 1
Operational ranges and cut points of the DASS/HADS subscales.
Figure 2
Figure 2
Co-calibration of HADS 'Probable' Depression Cut Point (1) with DASS. Read a score of 11 across to the HADS line (1); then read up to the DASS line (2), and then read back to the raw score, which in this example shows 27 (Rounded).
See this image and copyright information in PMC

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