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Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the hospital, Anxiety and Depression Scale (HADS)

Tanya Covic14*, Steven R Cumming2, Julie F Pallant3, Nick Manolios4, Paul Emery5, Philip G Conaghan5 and Alan Tennant5

Author Affiliations

1 School of Psychology, University of Western Sydney, Australia

2 Faculty of Health Sciences, University of Sydney, Australia

3 Rural Health Academic Centre, University of Melbourne, Australia

4 School of Medicine, University of Sydney, Australia

5 Leeds Institute of Molecular Medicine, Section of Musculoskeletal Disease, Faculty of Medicine and Health, University of Leeds, UK

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BMC Psychiatry 2012, 12:6  doi:10.1186/1471-244X-12-6

Published: 24 January 2012



While it is recognised that depression is prevalent in Rheumatoid Arthritis (RA), recent studies have also highlighted significant levels of anxiety in RA patients. This study compared two commonly used scales, the Depression Anxiety and Stress Scale (DASS) and the Hospital Anxiety and Depression Scale (HADS), in relation to their measurement range and cut points to consider the relative prevalence of both constructs, and if prevalence rates may be due to scale-specific case definition.


Patients meeting the criteria for RA were recruited in Leeds, UK and Sydney, Australia and asked to complete a survey that included both scales. The data was analysed using the Rasch measurement model.


A total of 169 RA patients were assessed, with a repeat subsample, resulting in 323 cases for analysis. Both scales met Rasch model expectations. Using the 'possible+probable' cut point from the HADS, 58.3% had neither anxiety nor depression; 13.5% had anxiety only; 6.4% depression only and 21.8% had both 'possible+probable' anxiety and depression. Cut points for depression were comparable across the two scales while a lower cut point for anxiety in the DASS was required to equate prevalence.


This study provides further support for high prevalence of depression and anxiety in RA. It also shows that while these two scales provide a good indication of possible depression and anxiety, the estimates of prevalence so derived could vary, particularly for anxiety. These findings are discussed in terms of comparisons across studies and selection of scales for clinical use.