Practical issues in psychosocial measures.

Abstract

Psychosocial variables were recognized as key clinical determinants and outcomes in rheumatic disease. Clinical interventions can produce clinically important improvement in psychological status, and clinicians regularly employ anxiolytic and antidepressant drugs. Yet assessment of psychological status is rarely undertaken in routine clinical practice. In part, this failure stems from the fact that most formal psychological instruments are too complicated, take too much time to administer, cannot be administered in real time, and are difficult to interpret. A practical way to assess psychological status in the clinic is to use short depression instruments such as the Center for Epidemiological Studies Depression scale (CES-D) or the Arthritis Impact Measurement Scales (AIMS) anxiety and depression subscales. Another approach to psychological assessment is to measure surrogate variables, that is, variables that are not primarily psychological and have practical use in rheumatic disease care. The Clinical Health Assessment Questionnaire (CLINHAQ) assesses such surrogate variables via visual analog scales for pain, fatigue, and sleep disturbance, the helplessness subscale of the Rheumatology Attitudes index, a self-report measure of satisfaction with health, and the AIMS anxiety and depression scales. This instrument, which also contains the Health Assessment Questionnaire disability index, a pain diagram, and assessment of global severity, can be completed in 5 minutes by almost all clinic patients.