title: Prevalence of depressive and anxiety disorders and validation of the Hospital Anxiety and Depression Scale as a screening tool in axial spondyloarthritis patients.
abstract: OBJECTIVE
  To determine the prevalence of anxiety and depression in axial spondyloarthritis (SpA) patients by a psychiatrist using the Chinese-bilingual Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition patient research version (CB-SCID-I/P), and to examine the effectiveness of the Hospital Anxiety and Depression Scale (HADS) as a screening tool.
  
  
  METHODS
  We recruited 160 Chinese axial-SpA patients to determine the prevalence of anxiety and depression using the CB-SCID-I/P. Recruited subjects were asked to complete the HADS. HADS, HADS-depression (HADS-D) subscale and HADS-anxiety (HADS-A) subscale were analyzed to determine their effectiveness in screening for depressive and anxiety disorders.
  
  
  RESULTS
  The prevalence of current major depressive disorder (MDD) and anxiety disorder were 10.6% and 15.6%, respectively. The full-scale HADS outperformed the HADS-D subscale in screening for current MDD (area under the curve [AUC] 0.889; 0.844) and all depressive disorders (AUC 0.885; 0.862) while the HADS-A subscale outperformed the full scale HADS in screening for anxiety disorders (AUC 0.894; 0.846). The optimal cut-off point of the full scale HADS for screening current MDD and all depressive disorders were 7/8 and 6/7, yielding a sensitivity of 82.4% and 83.9%, specificity of 78.7% and 74.8%, respectively. The optimal cut-off point of HADS-A subscale for screening anxiety disorders was 6/7, yielding a sensitivity of 88.0% and specificity of 74.4%.
  
  
  CONCLUSIONS
  The prevalence of MDD and anxiety disorder in SpA patients were 10.6% and 15.6%, respectively. We recommend using the full-scale HADS in screening for depressive disorders and HADS-A subscale for anxiety disorders.
authors.affiliation: Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
authors.forename: Cynthia Y Y
authors.initials: CYY
authors.lastname: Chan
authors.affiliation: Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, Hong Kong, China.
authors.forename: Helen H L
authors.initials: HHL
authors.lastname: Tsang
authors.affiliation: Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, Hong Kong, China.|Division of Rheumatology and Clinical Immunology, University of Hong Kong, Hong Kong, China.
authors.forename: C S
authors.initials: CS
authors.lastname: Lau
authors.affiliation: Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, Hong Kong, China.
authors.forename: H Y
authors.initials: HY
authors.lastname: Chung
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D019540:Area Under Curve; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D015203:Reproducibility of Results; D025241:Spondylarthritis / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology
keywords: anxiety disorder; depressive disorder; hospital anxiety and depression scale; spondyloarthritis