Objective
Thirty percent of people with SLE report anxiety and/or depression. [1] Assessment by patient self-report is feasible in busy clinical settings but use of complex questionnaires is impractical. The MDHAQ is validated to assess disease activity in rheumatic diseases. This study aimed to investigate the utility of three biopsychosocial questions of the MDHAQ in detecting mental health symptoms in SLE compared with the SF36.
Methods
People with SLE, attending the Liverpool Hospital lupus clinic, were enrolled in a cross sectional study. An MDHAQ and SF36 were completed at the same visit. Three questions from the MDHAQ regarding sleep, anxiety and depression ("SAD3") were compared with the Mental Component Summary (MCS) score of the SF36. The sum of, and individual scores for the three questions, were analysed using Spearman’s rank correlation. MCS scores were compared between those with scores of 3.3 or lower and those with 4.4 or higher.
Results
Seventy patients were recruited (59 females). 42% identified as Asian and the mean age was 44 years. The majority reported difficulty in either sleep (72%), feeling anxious (64%) or depressed (51%). The correlation between the MCS score and the combined score of the three MDHAQ questions was 0.74 (95% CI 0.62 to 0.84, p<0.0001). The mean MCS for those with a score on the MDHAQ of 3.3 (n=44) or lower was 51.1. The mean MCS for those with a score of 4.4 (n=26) or higher was 32.9 (p<0.0001).
Conclusion
In people with SLE, a simple composite score of three MDHAQ biopsychosocial questions, the SAD3, correlated strongly with the SF36 MCS. A score of 4.4 or more using 3 MDHAQ responses detects mental health symptoms in SLE and can alert the physician to the need for further mental health assessment. This simple tool is feasible for use in routine clinical care.