A comparison of self‐reports of distress and affective disorder diagnoses in rheumatoid arthritis: A receiver operator characteristic analysis

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.