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BioMed Research International
Volume 2013, Article ID 507493, 8 pages
Research Article

In Systemic Sclerosis, Anxiety and Depression Assessed by Hospital Anxiety Depression Scale Are Independently Associated with Disability and Psychological Factors

1Department of Experimental and Clinical Medicine, Division of Rheumatology, Denothe Centre, Careggi Hospital (AOUC), University of Florence, Viale Pieraccini 18, 50139 Firenze, Italy
2ASL 10 Physiotherapy Outpatient Clinic and School of Physiotherapy, University of Florence, Viale Pieraccini 18, 50139 Firenze, Italy

Received 4 April 2013; Revised 13 June 2013; Accepted 2 July 2013

Academic Editor: Francesco Del Galdo

Copyright © 2013 Angela Del Rosso et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Anxious and depressive symptoms are frequent in Systemic Sclerosis (SSc). Our objective is to assess their prevalence and association with district and global disability and psychological variables. Methods. 119 SSc patients were assessed by Hospital Anxiety Depression Scale (HADS). Clinical depression and anxiety were defined for HADS score cutoff ≥8. Patients were assessed for psychological symptoms (RSES, COPE-NIV), hand (HAMIS, CHFDS, fist closure, and hand opening) and face disability (MHISS, mouth opening), global disability, and fatigue (HAQ, FACIT). Results. Both depression and anxiety in SSc are 36%. Depressive patients with comorbid anxiety have higher HADS-D score than patients with depression only ( ). HADS-A and -D are positively correlated with global disability, hands and mouth disability, fatigue, self-esteem and avoidance coping strategy, and, only HADS-A, also with social support ( ). By multiple regression, HADS-D is independently associated with FACIT-F ( ), RSES ( ), and MHISS total score ( ), together explaining 50% of variance. HADS-A is independently associated with RSES ( ), COPE-NIV SA ( ), COPE-NIV SS ( ), FACIT-F ( ), and MHISS mouth opening ( ), explaining 41% of variance. Conclusions. In SSc depression and anxiety correlate to local and global disabilities and psychological characteristics. Depressive patients with comorbid anxiety have higher level of depressive symptoms.