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Validation of Six Short and Ultra-short Screening Instruments for Depression for People Living with HIV in Ontario: Results from the Ontario HIV Treatment Network Cohort Study.

Choi SK, Boyle E, Burchell AN, Gardner S, Collins E, Grootendorst P, Rourke SB, OHTN Cohort Study Gro - PLoS ONE (2015)

Bottom Line: Results from the three instruments and their short forms were compared to results from the gold standard measured by Mini International Neuropsychiatric Interview (the "M.I.N.I.").We did not find that the AUCs differed in instrument pairs (p-value>0.09), or between the instruments and their short forms (p-value>0.3).When further in-depth assessments become available, shorter instruments might find greater clinical acceptance.

View Article: PubMed Central - PubMed

Affiliation: The Ontario HIV Treatment Network, Toronto, Ontario, Canada.

ABSTRACT

Objective: Major depression affects up to half of people living with HIV. However, among HIV-positive patients, depression goes unrecognized 60-70% of the time in non-psychiatric settings. We sought to evaluate three screening instruments and their short forms to facilitate the recognition of current depression in HIV-positive patients attending HIV specialty care clinics in Ontario.

Methods: A multi-centre validation study was conducted in Ontario to examine the validity and accuracy of three instruments (the Center for Epidemiologic Depression Scale [CESD20], the Kessler Psychological Distress Scale [K10], and the Patient Health Questionnaire depression scale [PHQ9]) and their short forms (CESD10, K6, and PHQ2) in diagnosing current major depression among 190 HIV-positive patients in Ontario. Results from the three instruments and their short forms were compared to results from the gold standard measured by Mini International Neuropsychiatric Interview (the "M.I.N.I.").

Results: Overall, the three instruments identified depression with excellent accuracy and validity (area under the curve [AUC]>0.9) and good reliability (Kappa statistics: 0.71-0.79; Cronbach's alpha: 0.87-0.93). We did not find that the AUCs differed in instrument pairs (p-value>0.09), or between the instruments and their short forms (p-value>0.3). Except for the PHQ2, the instruments showed good-to-excellent sensitivity (0.86-1.0) and specificity (0.81-0.87), excellent negative predictive value (>0.90), and moderate positive predictive value (0.49-0.58) at their optimal cut-points.

Conclusion: Among people in HIV care in Ontario, Canada, the three instruments and their short forms performed equally well and accurately. When further in-depth assessments become available, shorter instruments might find greater clinical acceptance. This could lead to clinical benefits in fast-paced speciality HIV care settings and better management of depression in HIV-positive patients.

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Related in: MedlinePlus

Comparison Between Adjusted ROC Curves of the Original Instruments for Current Major Depression and that of their Corresponding Reduced Scales After Removing Items Related to Somatic Symptoms of HIV (N = 179a); Footnotes: All reported 95% confidence intervals were constructed by bias-corrected bootstrap method with 2000 replicates (Efron & Tibshirani, 1994); AUC = Area under the curve; aOf 190 patients, 179 provided demographic, psychosocial and behavioural information; bItems (i.e., fatigue, sleep, appetite, not being able to shake the blues, feeling bothered, feeling depressed, and lack of concentration) correspond to previously reported somatic symptoms of HIV infection (Kalichman, Rompa, &Cage, 2000).
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pone.0142706.g003: Comparison Between Adjusted ROC Curves of the Original Instruments for Current Major Depression and that of their Corresponding Reduced Scales After Removing Items Related to Somatic Symptoms of HIV (N = 179a); Footnotes: All reported 95% confidence intervals were constructed by bias-corrected bootstrap method with 2000 replicates (Efron & Tibshirani, 1994); AUC = Area under the curve; aOf 190 patients, 179 provided demographic, psychosocial and behavioural information; bItems (i.e., fatigue, sleep, appetite, not being able to shake the blues, feeling bothered, feeling depressed, and lack of concentration) correspond to previously reported somatic symptoms of HIV infection (Kalichman, Rompa, &Cage, 2000).

Mentions: When we removed items (i.e., fatigue, sleep, appetite, not being able to shake the blues, feeling bothered, feeling depressed, and lack of concentration) [32] that were previously reported as somatic symptoms of HIV infection from the original screening instruments and their short forms for current major depression, we found that the results of adjusted AUCs of CESD20 (p-value = 0.0019), CESD10 (p-value = 0.017) and PHQ2 (p-value = 0.023) were significantly reduced (Fig 3).


Validation of Six Short and Ultra-short Screening Instruments for Depression for People Living with HIV in Ontario: Results from the Ontario HIV Treatment Network Cohort Study.

Choi SK, Boyle E, Burchell AN, Gardner S, Collins E, Grootendorst P, Rourke SB, OHTN Cohort Study Gro - PLoS ONE (2015)

Comparison Between Adjusted ROC Curves of the Original Instruments for Current Major Depression and that of their Corresponding Reduced Scales After Removing Items Related to Somatic Symptoms of HIV (N = 179a); Footnotes: All reported 95% confidence intervals were constructed by bias-corrected bootstrap method with 2000 replicates (Efron & Tibshirani, 1994); AUC = Area under the curve; aOf 190 patients, 179 provided demographic, psychosocial and behavioural information; bItems (i.e., fatigue, sleep, appetite, not being able to shake the blues, feeling bothered, feeling depressed, and lack of concentration) correspond to previously reported somatic symptoms of HIV infection (Kalichman, Rompa, &Cage, 2000).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4643910&req=5

pone.0142706.g003: Comparison Between Adjusted ROC Curves of the Original Instruments for Current Major Depression and that of their Corresponding Reduced Scales After Removing Items Related to Somatic Symptoms of HIV (N = 179a); Footnotes: All reported 95% confidence intervals were constructed by bias-corrected bootstrap method with 2000 replicates (Efron & Tibshirani, 1994); AUC = Area under the curve; aOf 190 patients, 179 provided demographic, psychosocial and behavioural information; bItems (i.e., fatigue, sleep, appetite, not being able to shake the blues, feeling bothered, feeling depressed, and lack of concentration) correspond to previously reported somatic symptoms of HIV infection (Kalichman, Rompa, &Cage, 2000).
Mentions: When we removed items (i.e., fatigue, sleep, appetite, not being able to shake the blues, feeling bothered, feeling depressed, and lack of concentration) [32] that were previously reported as somatic symptoms of HIV infection from the original screening instruments and their short forms for current major depression, we found that the results of adjusted AUCs of CESD20 (p-value = 0.0019), CESD10 (p-value = 0.017) and PHQ2 (p-value = 0.023) were significantly reduced (Fig 3).

Bottom Line: Results from the three instruments and their short forms were compared to results from the gold standard measured by Mini International Neuropsychiatric Interview (the "M.I.N.I.").We did not find that the AUCs differed in instrument pairs (p-value>0.09), or between the instruments and their short forms (p-value>0.3).When further in-depth assessments become available, shorter instruments might find greater clinical acceptance.

View Article: PubMed Central - PubMed

Affiliation: The Ontario HIV Treatment Network, Toronto, Ontario, Canada.

ABSTRACT

Objective: Major depression affects up to half of people living with HIV. However, among HIV-positive patients, depression goes unrecognized 60-70% of the time in non-psychiatric settings. We sought to evaluate three screening instruments and their short forms to facilitate the recognition of current depression in HIV-positive patients attending HIV specialty care clinics in Ontario.

Methods: A multi-centre validation study was conducted in Ontario to examine the validity and accuracy of three instruments (the Center for Epidemiologic Depression Scale [CESD20], the Kessler Psychological Distress Scale [K10], and the Patient Health Questionnaire depression scale [PHQ9]) and their short forms (CESD10, K6, and PHQ2) in diagnosing current major depression among 190 HIV-positive patients in Ontario. Results from the three instruments and their short forms were compared to results from the gold standard measured by Mini International Neuropsychiatric Interview (the "M.I.N.I.").

Results: Overall, the three instruments identified depression with excellent accuracy and validity (area under the curve [AUC]>0.9) and good reliability (Kappa statistics: 0.71-0.79; Cronbach's alpha: 0.87-0.93). We did not find that the AUCs differed in instrument pairs (p-value>0.09), or between the instruments and their short forms (p-value>0.3). Except for the PHQ2, the instruments showed good-to-excellent sensitivity (0.86-1.0) and specificity (0.81-0.87), excellent negative predictive value (>0.90), and moderate positive predictive value (0.49-0.58) at their optimal cut-points.

Conclusion: Among people in HIV care in Ontario, Canada, the three instruments and their short forms performed equally well and accurately. When further in-depth assessments become available, shorter instruments might find greater clinical acceptance. This could lead to clinical benefits in fast-paced speciality HIV care settings and better management of depression in HIV-positive patients.

Show MeSH
Related in: MedlinePlus