Evaluation of Psychological Distress in the Rheumatology Clinic

Fig. 12.1 Example procedure for assessing depression and anxiety within a rheumatology clinic

It is important for the medical team to stay connected and supportive with patients and flexible through the implementation of the screening and referral process. While screening measures serve the purpose of objectively assessing depression and anxiety, addressing these symptoms with patients and the need for intervention will be most effective if patients are met with respect, are given the opportunity to take advantage of individualized treatment plans, and are monitored consistently through follow-up. Importantly, while many screening measures have cutoff points that increase the odds of a psychiatric diagnosis, these data should not be used alone in determining the need for follow-up care. Other verbal information obtained during interactions with professionals performing the screening or the medical visit may suggest the need for additional evaluation and management. For example, patients may report problems with sleep, diet or family and work-related issues that are distressing and merit clinical attention. Difficulties of this nature are important to identify since they may compromise quality of life and interfere with medical treatment and adherence.

Several evidence-based interventions are available for managing depression, anxiety, and the difficult symptoms of arthritis. The screening and evaluation process plays a major role in identifying those patients who are in the greatest need for psychosocial care. Matching patients with the appropriate intervention is essential for the successful improvement of symptoms. Chapters 13, 14, 15, and 16 of this text provide an overview of potentially effective interventions for arthritis patients. Importantly, the support and active involvement of the medical team is crucial to the screening and referral process and the adoption of integrated care in the rheumatology setting. While depression and anxiety create a significant burden for many arthritis patients, these are very treatable disorders that must first be identified and evaluated as patients receive their medical care. Successful treatment requires coordinated treatment between mental health professionals and the rheumatology team and the willingness to broaden the focus of medical care.

References

Affleck, G., Tennen, H., Keefe, F. J., Lefebvre, J. C., Kashikar-Zuck, S., Wright, K., … Caldwell, D. S. (1999). Everyday life with osteoarthritis or rheumatoid arthritis: Independent effects of disease and gender on daily pain, mood, and coping. Pain, 83(3), 601–609.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Ang, D. C., Choi, H., Kroenke, K., & Wolfe, F. (2005). Comorbid depression is an independent risk factor for mortality in patients with rheumatoid arthritis. Journal of Rheumatology, 32, 1013–1019.PubMed

Arroll, B., Khin, N., & Kerse, N. (2003). Screening for depression in primary care with two verbally asked questions: Cross sectional study. British Medical Journal, 327(7424), 1144–1146. http://dx.doi.org/10.1136/bmj.327.7424.1144.PubMedCentralPubMed

Beck, A. T., Guth, D., Steer, R., & Ball, R. (1997). Screening for major depression disorders in medical inpatients with the beck depression inventory for primary care. Behaviour Research and Thearpy, 35(8), 785–791.

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York, NY: Guilford Press.

Beck, A. T., Steer, R. A., & Brown, G. K. (2000). BDI: Fast screen for medical patients manual. San Antonio, TX: The Psychological Corporation.

Beekman, A. T. F., Deeg, D. J. H., Limbeek, J. V., Braam, A. W., De Vries, M. Z., & Tilburg, W. V. (1997). Brief communication: Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): Results from a community-based sample of older subjects in the Netherlands. Psychological Medicine, 27(1), 231–235.PubMed

Bergeron, J. (1983). State-trait anxiety in French-English bilinguals: Cross-cultural considerations. Series in Clinical & Community Psychology: Stress & Anxiety, 2, 157–176.

Bidstrup, P. E., Johansen, C., & Mitchell, A. J. (2011). Screening for cancer-related distress: Summary of evidence from tools to programmes. Acta Oncologica, 50(2), 194–204.PubMed

Bjelland, I., Dahl, A. A., Haut, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic Research, 52(2), 69–77.PubMed

Blixen, C. E., & Kippes, C. (1999). Depression, social support, and quality of life in older adults with osteoarthritis. Image: The Journal of Nursing Scholarship, 31(3), 221–226.

Bruce, T. O. (2008). Comorbid depression in rheumatoid arthritis: Pathophysiology and clinical implications. Current Psychiatry Reports, 10(3), 258–264.PubMed

Carlson, L. E., Groff, S. L., Maciejewski, O., & Bultz, B. D. (2010). Screening for distress in lung and breast cancer outpatients: A randomized controlled trial. Journal of Clinical Oncology, 28(33), 4884–4891.PubMed

Chang, A. C. (1996). Clinical validation of the Geriatric Depression Scale (GDS) Chinese version. Journal of Aging and Health, 8(2), 238–253.

Chapman, D., Perry, G., & Strine, T. (2005). The vital link between chronic disease and depressive disorders. Preventing Chronic Disease, 2(1), 1–10.

Choi, J. H., Chung, K. M., & Park, K. (2013). Psychosocial predictors of four health-promoting behaviors for cancer prevention using the stage of change of Transtheoretical Model. Psycho-Oncology, 22(10), 2253–2261.PubMed

Culpepper, L., Clayton, A., Lieberman, J., III, & Susman, J. (2008). Treating depression and anxiety in primary care. The Primary Care Companion to the Journal of Clinical Psychiatry, 10(2), 145–152. Retrieved May 20, 2015

Dagnan, D., Chadwick, P., & Trower, P. (2000). Psychometric properties of the Hospital Anxiety and Depression Scale with a population of members of a depression self-help group. British Journal of Medical Psychology, 73(1), 129–137.PubMed

Davidson, K. W., Kupfer, D. J., Bigger, J. T., Califf, R. M., Carney, R. M., Coyne, J. C., … Suls, J. M. (2006). Assessment and treatment of depression in patients with cardiovascular disease: National Heart, Lung, and Blood Institute Working Group Report. Annals of Behavioral Medicine, 32(2), 121–126.

Davies, K. N., Burn, W. K., McKenzie, F. R., Brothwell, J. A., & Wattis, J. P. (1993). Evaluation of the hospital anxiety and depression scale as a screening instrument in geriatric medical inpatients. International Journal of Geriatric Psychiatry, 8(2), 165–169.

DiMatteo, M. R., Lepper, H. S., & Croghan, T. W. (2000). Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine, 160(14), 2101–2107.PubMed

Dolbeault, S., Boistard, B., Meuric, J., Copel, L., & Brédart, A. (2011). Screening for distress and supportive care needs during the initial phase of the care process: A qualitative description of a clinical pilot experiment in a French cancer center. Psycho-Oncology, 20(6), 585–593.PubMed

Dudgeon, D., King, S., Howell, D., Green, E., Gilbert, J., Hughes, E., … Sawka, C. (2012). Cancer Care Ontario’s experience with implementation of routine physical and psychological symptom distress screening. Psycho – Oncology, 21(4), 357–364.

Eccleston, C. (2001). Role of psychology in pain management. British Journal of Anaesthesia, 87(1), 144–152.PubMed

Egede, L. E., Zheng, D., & Simpson, K. (2002). Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care, 25(3), 464–470.PubMed

Eisenberg, L. (1992). Treating depression and anxiety in primary care: Closing the gap between knowledge and practice. New England Journal of Medicine, 326, 1080–1084.PubMed

Epstein, O., Perkin, D., Cookson, J., Watt, I., Rakhit, R., Robbins, A., & Hornett, G. (2009). Pocket guide to clinical examination (4th ed.). Edinburgh: Mosby Elsevier.

Fawzy, F. I., Fawzy, N. W., Hyun, C. S., Elashoff, R., Guthrie, D., Fahey, J. L., & Morton, D. L. (1993). Malignant melanoma: Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Archives of General Psychiatry, 50, 681–689.

Fifield, J., Tennen, H., Reisine, S., & McQuillan, J. (1998). Depression and the long-term risk of pain, fatigue, and disability in patients with rheumatoid arthritis. Arthritis & Rheumatism, 41, 1851–1857.

Frasure-Smith, N. (1991). In-hospital symptoms of psychological stress as predictors of long-term outcome after acute myocardial infarction in men. The American Journal of Cardiology, 67(2), 121–127.PubMed

Fydrich, T., Dowdall, D., & Chambless, D. L. (1993). Reliability and validity of the beck anxiety inventory. Journal of Anxiety Disorders, 6(1), 55–61.

Garcia-Campayo, J., Zamorano, E., Ruiz, M., Pardo, A., Perez-Paramo, M., Lopez-Gomez, V., … Rejas, J. (2010). Cultural adaptation into Spanish of the generalized anxiety disorder-7 (GAD-7) scale as a screening tool. Health and Quality of Life Outcomes, 8(8), 1–11.

Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133(4), 581.PubMed

Ghassemzadeh, H., Mojtabai, R., Karamghadiri, N., & Ebrahimkhani, N. (2005). Psychometric properties of a Persian-language version of the Beck Depression Inventory—Second edition: BDI-II-PERSIAN. Depression and Anxiety, 21(4), 185–192.PubMed

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