Screening for mental disorders in cardiac and orthopaedic rehabilitation

Abstract

The detection of patients with comorbid mental disorders is of high clinical importance in cardiac and orthopaedic rehabilitation. To simplify detection of cases, screening instruments are recommended. This study investigated the discriminant validity of the General Health Questionnaire (GHQ-12) and the Hospital Anxiety and Depression Scale (HADS-D) to identify patients with comorbid mental disorders and specifically affective or anxiety disorders. 213 patients with cardiovascular diseases and 206 patients with musculoskeletal diseases participated in a two-stage survey. Patients were assessed with the GHQ-12 and the HADS-D; and they were examined for DSM-IV mental disorders by clinical standardized interview (CIDI). Validity of the two screenings regarding the detection of mental disorders was compared using ROC-analysis. In both patient groups the HADS-D performed better in nearly all analyses compared to the GHQ-12, especially in the detection of affective disorders (AUC in cardiac patients 0.78, in orthopaedic patients 0.79). Both screening instruments can be used for the detection of comorbid affective and anxiety disorders in patients with cardiovascular and musculoskeletal diseases. Limitations in performance of screening instruments are due to the different methodological approaches of tests as well as to difficulties in diagnosing mental disorders in patients with physical illness.