title: Validation of Standardized Questionnaires Evaluating Symptoms of Depression in Rheumatoid Arthritis Patients: Approaches to Screening for a Frequent Yet Underrated Challenge.
abstract: 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.
  
  
  
  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.
  
  
  
  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 (rs= 0.77), which also achieved the best results for both sensitivity and specificity (>80%) when using the MADRS as the gold standard.
  
  
  
  The BDI-II best met the predefined criteria, and the PHQ-9 met most of the validity criteria, with lower sensitivity and specificity.
authors.affiliation: University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Englbrecht
authors.affiliation: University Medicine Berlin, Berlin, Germany.
authors.forename: Rieke
authors.initials: R
authors.lastname: Alten
authors.affiliation: University Clinical Center Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Aringer
authors.affiliation: University of Leipzig, Leipzig, Germany.
authors.forename: Christoph G
authors.initials: CG
authors.lastname: Baerwald
authors.affiliation: Johann Wolfgang Goethe University Frankfurt am Main, Frankfurt, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Burkhardt
authors.affiliation: AMS Advanced Medical Services GmbH, Mannheim, Germany.
authors.forename: Nancy
authors.initials: N
authors.lastname: Eby
authors.affiliation: Rheumatologische Schwerpunktpraxis, Stuttgart, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Fliedner
authors.affiliation: Roche Pharma AG, Grenzach-Wyhlen, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Gauger
authors.affiliation: University Hospital Frankfurt am Main Goethe-University, Frankfurt, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Henkemeier
authors.affiliation: Chugai Pharma Europe Ltd., Frankfurt, Germany.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Hofmann
authors.affiliation: University Hospital of Wuerzburg, Wuerzburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kleinert
authors.affiliation: Klinikum Suedstadt Rostock, Klinik für Innere Medizin II, Rostock, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Kneitz
authors.affiliation: Praxiszentrum St. Bonifatius, Munich, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Krueger
authors.affiliation: University Medicine Berlin, Berlin, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Pohl
authors.affiliation: Roche Pharma AG, Grenzach-Wyhlen, Germany.
authors.forename: Anne-Eve
authors.initials: AE
authors.lastname: Roske
authors.affiliation: University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Schett
authors.affiliation: University of Wuerzburg, Wuerzberg, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Schmalzing
authors.affiliation: University Clinical Center Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
authors.forename: Anne-Kathrin
authors.initials: AK
authors.lastname: Tausche
authors.affiliation: University of Wuerzburg, Wuerzberg, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Peter Tony
authors.affiliation: Rheumatologische Schwerpunktpraxis, Erlangen, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Wendler
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000523:psychology*; D003863:Depression / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D011594:Psychometrics / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires / Q000592:standards