“In many cases, we’re not talking about a diagnosable clinical depression. There are a lot of people who are below the threshold of clinical depression, but still suffering. My research looked specifically at RA and the relationships between joint tenderness and depression and anxiety—and how symptoms of depression and anxiety affect RA symptoms,” she says. Depression is also prevalent in fibromyalgia.
Start the Conversation
Dr. Matcham
Rheumatologists can create space in the clinical encounter to start a conversation about how psychiatric issues may exacerbate rheumatologic conditions. Ask how the patient is feeling, rather than focusing just on their blood counts, Dr. Matcham says. “It’s important to talk about things that aren’t just physical. But then what do you do? For some rheumatologists, it could open a can of worms if they don’t know what to do about the problems that are uncovered.
“We have a project here,” says Dr. Matcham, “to integrate mental health into physical health without adding too much cost, knowing that clinicians are busy and health services chronically underfunded. We’re not talking about turning rheumatologists into psychologists, but about making them aware of these other, mental health aspects of the patient’s life. We set up a system [so that] when [a patient] comes in for a routine rheumatologic appointment, [they’re] given a questionnaire to complete in the waiting room on an iPad.” The results, identifying symptoms of anxiety or probable depression, go straight to the rheumatologist.
Dr. Matcham says a brief, one-item assessment has been shown to predict outcomes, demonstrating that a mental health assessment doesn’t have to be long and complex to identify people at risk of poor health outcomes.14 The SF-36 Short Form Health Survey is another easy way to screen for mental health issues and is widely used in other healthcare settings, Dr. Evers adds.
“What we say to rheumatologists is this: Screen your patients in routine practice, using a questionnaire. Ask about the consequences in their daily lives. If they are at risk, refer them for specialized help,” Dr. Evers says. “We use a stepwise approach.” All patients are given information about adjustment to chronic illness and offered access to disease-specific self-help websites. Some patients may be referred to a nurse in the rheumatology practice or back to the general practitioner, who has more time to devote to these issues. A small group may need additional treatment from a psychologist.