期刊
NEPHROLOGY DIALYSIS TRANSPLANTATION
卷 38, 期 5, 页码 1318-1326出版社
OXFORD UNIV PRESS
DOI: 10.1093/ndt/gfac262
关键词
2-step screening; depressive symptoms; kidney failure; PHQ-9; PROMIS
A two-step screening using ultrabrief pre-screeners followed by the Patient-Reported Outcomes Measurement Information System Depression questionnaire can effectively identify depressive symptoms in patients on kidney replacement therapies and reduce question burden.
Background Systematic screening for depressive symptoms may identify patients who may benefit from clinical assessment and psychosocial support. Here we assess a two-step screening using ultrabrief pre-screeners [Edmonton Symptom Assessment Survey-revised Depression item (ESASr-D) or Patient Health Questionnaire-2 (PHQ-2)] followed by the Patient-Reported Outcomes Measurement Information System Depression questionnaire (PROMIS-D) to identify depressive symptoms in patients on kidney replacement therapies. Methods We conducted a cross-sectional study of adults (kidney transplant recipients or treated with dialysis) in Toronto, ON, Canada. We simulated various two-step screening scenarios where only patients above a pre-screening cut-off score on the ESASr-D or PHQ-2 would move to step 2 (PROMIS-D). Screening performance was evaluated by sensitivity, specificity and positive and negative predictive values using the Patient Health Questionnaire-9 (PHQ-9) as the referent. The average number of items completed by patients in different scenarios was reported. Results Of 480 participants, 60% were male with a mean age of 55 years. Based on PHQ-9, 19% of patients had moderate or severe depressive symptoms. Pre-screening with a PHQ-2 score >= 1 combined with a PROMIS-D score of >= 53 provided the best two-step results (sensitivity 0.81, specificity 0.84, NPV 0.95). Two-step screening also reduces question burden. Conclusions A two-step screening using a PHQ-2 score >= 1 followed by a PROMIS-D score >= 53 has good sensitivity and specificity for identifying potentially significant depressive symptoms among patients on kidney replacement therapies. This approach has lower question burden. Screened-in patients will need further clinical assessment to establish a diagnosis.
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