Screening for Anxiety, Depression, and Fibromyalgia in Routine Care of All Rheumatic Diagnoses on a Multidimensional Health Assessment Questionnaire (MDHAQ)

Objective To analyze unselected routine care patients with all rheumatic diagnoses for positive anxiety, depression, and/or fibromyalgia (FM) screening within a single Multidimensional Health Assessment Questionnaire (MDHAQ), and for pain and Routine Assessment of Patient Index Data 3 (RAPID3) in patients with positive vs negative screens.

Methods Each rheumatology patient with any diagnosis at Rush University is given an MDHAQ at each encounter to provide comprehensive medical history information, completed by most patients in 5-10 minutes and scored by a professional in < 30 seconds. Frequencies of positive MDHAQ anxiety, depression, and FM screening indices were computed in patients with 15 rheumatic diagnoses in 5 categories: inflammatory, connective tissue, noninflammatory, bone mineral disorders, and primary FM. Median pain on a 0-10 visual numeric scale and RAPID3 scores from 0 to 30 were compared in patients with positive vs negative screens.

Results In 1337 study patients (excluding primary FM), 30% had positive screens for anxiety, 24% for depression, and 25% for nonprimary FM, and 44% any of these 3 multimorbidity screens. Positive screens in different rheumatic diagnosis categories ranged from 17-39% for anxiety, 9-33% for depression, 7-31% for nonprimary FM, and 30-52% for any multimorbidity screen. Median pain was 7.0/10 vs 4.0/10 and median RAPID3 17.0/30 vs 8.2/30 in patients with any of 3 positive vs all negative screens, respectively.

Conclusion Positive anxiety, depression, and/or FM screens in 44% of routine care patients who have significantly higher pain scores agree with extensive research findings, suggesting inclusion of pragmatic screening for clinical decisions at all routine encounters.