Quantifying the burden of emotional ill-health amongst patients referred to a specialist rheumatology service.
OBJECTIVE
(1) To determine the prevalence of emotional disorders (DSM IV depression, anxiety and panic disorders) amongst patients referred to a rheumatology out-patient service and the proportion of these detected by the rheumatologist. (2) To test the hypotheses that emotional disorders are associated with (i) broad categories of rheumatological diagnosis (systemic, inflammatory vs non-systemic, non-inflammatory), (ii) female gender, (iii) greater symptom burden and disability and (iv) markers of socio-economic deprivation.


METHODS
A cross-sectional study was made of consecutive newly referred attenders at a hospital-based, regional rheumatology service. Emotional disorders, pain, health status and socio-economic factors were assessed by questionnaire. The letter to the referrer was scrutinized for the rheumatological diagnosis and mention of emotional disorder.


RESULTS
A total of 256 patients were eligible and 203 (79%) participated. The sample was 69% female, had a mean age of 50 yr and 68 patients (33.5%) had one or more emotional disorders. Only a minority were detected. There was no association with type of rheumatological diagnosis. Patients with an emotional disorder were more likely to be female (81 vs 62%; P<0.007), to report more pain (mean Visual Analogue Score 70 vs 50 mm, P<0.001), a greater number of somatic symptoms (median 3 vs 1, P<0.001) and greater disability (median Health Assessment Questionnaire 1.1 vs 0.5, P<0.001). Emotional disorders were also associated with some, but not all, measures of lower social and economic status and life dissatisfaction.


CONCLUSIONS
Emotional disorder is present in one-third of new rheumatology referrals. The course, causation and management of this important component of rheumatological illness merit further attention.
Rheumatic Diseases Unit, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK. nicolamaiden@hotmail.com
N L
NL
Maiden
N P
NP
Hurst
A
A
Lochhead
A J
AJ
Carson
M
M
Sharpe
D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000150:complications; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000150:complications; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010146:Pain / Q000523:psychology; D016584:Panic Disorder / Q000150:complications; D012017:Referral and Consultation; D012216:Rheumatic Diseases / Q000150:complications* / Q000523:psychology; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors