A Comparison of Self-reports of Distress and Affective Disorder Diagnoses in Rheumatoid Arthritis: A Receiver Operator Characteristic Analysis

Authors

• Julia McQuillan, University of Nebraska-LincolnFollow
• Judith Fifield, University of Connecticut Health Center
• T. Joseph Sheehan, University of Connecticut Health Center
• Susan Reisine, University of Connecticut Health Center
• Howard Tennen, University of Connecticut Health Center
• Victor Hesselbrock, University of Connecticut Health Center, MC-6325, Farmington, CT
• Naomi Rothfield, University of Connecticut Health Center

Document Type

Article

Date of this Version

June 2003

Citation

Arthritis Care and Research (2003) 49(3): 368–376

doi: 10.1002/art.11116

Comments

Copyright © 2003, American College of Rheumatology; published by Wiley. Used by permission

Abstract

Objective—To compare 3 commonly used psychiatric symptom checklists (the Center for Epidemiological Studies Depression Scale [CES-D], the Positive and Negative Affect Schedule, and the Endler Multidimensional Anxiety Scales [EMAS] to determine their sensitivity, specificity, and ability to discriminate between a disorder (Major Depression [MD], Generalized Anxiety Disorder [GAD], and no disorder. To compare the checklists for their ability to discriminate between type of disorder (MD and GAD). To evaluate the discriminant ability of the subscales, particularly positive affect; whether the somatic items in the CES-D artificially inflate affective scores; and the optimal cut off score for the CES-D.

Methods—We compared the 3 scales to diagnostic criterion of MD, GAD, and comorbid disorder using receiver operator characteristic (ROC) and logistic regression analyses. The sample consisted of a national panel of 415 individuals with rheumatoid arthritis (RA).

Results—Each of the scales had high sensitivity and specificity (areas under the curve: CES-D = 0.92, negative affect = 0.88, positive affect and EMAS = 0.82). The CES-D, however, demonstrated better sensitivity and specificity than the positive affect and the EMAS, but not the negative affect scale.

Conclusion—All 3 self-reports have high combined sensitivity and specificity as measures of affective disorders among RA patients.