Communication about depression during rheumatoid arthritis patient visits

The purpose of this study was to examine the extent of the presence of depression symptomatology among older adults with rheumatoid arthritis and the extent to which rheumatologists and patients discussed depression during routine visits. A total of four North Carolina rheumatology practices and 200 rheumatoid arthritis patients who were age 45 or greater participated in the study. All patients completed the Patient Health Questionnaire. The patient visits were audio-tape recorded. The audio-tapes were coded using a detailed coding instrument. Inter-coder reliability was greater than 0.80 for all measures. Multivariable linear and logistic regression techniques were used to analyze the data. Seventy-two percent of the patients were female; 66% were White; and 20% were African American. Patient age ranged from 45 to 88 (mean=62.5 years). According to the ACR functional classification, 24% of patients were classified as class 1, 44% class 2, 14% class 4, and 2% class 4. Nine percent of patients scored 15 or higher on the PHQ, indicating possible major depression. Patients with a worse ACR functional classification and less educated patients were significantly more likely to have higher PHQ scores. Only 23% of patients who screened as having possible major depression discussed depression or mood with their providers. When depression was discussed during visits, the patient initiated the discussion in all cases. Qualitative examples of depression communication will be presented.