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.