期刊
KIDNEY INTERNATIONAL
卷 69, 期 9, 页码 1662-1668出版社
NATURE PUBLISHING GROUP
DOI: 10.1038/sj.ki.5000308
关键词
depression; dialysis; sensitivity; specificity
资金
- NHLBI NIH HHS [R01 HL070713] Funding Source: Medline
- NIA NIH HHS [AG11268] Funding Source: Medline
- NIDDK NIH HHS [DK02724-01A1] Funding Source: Medline
The prevalence of depression in end- stage renal disease ( ESRD) patients on hemodialysis has not been definitively determined. We examined the prevalence of depression and the sensitivity, specificity, positive, and negative likelihood ratios ( + LR and - LR) of self-report scales using the physician-administered Structured Clinical Interview for Depression ( SCID) as the comparison. Ninety-eight consecutive patients completed the Beck Depression Inventory ( BDI) and the Center for Epidemiological Study of Depression ( CESD) scales. A physician blinded to BDI and CESD scores administered the SCID. Receiver/responder operating characteristic curves determined the best BDI and CESD cutoffs for depression. Depressed patients had more co-morbidities and lower quality of life, P < 0.05. The prevalence of depression by SCID was 26.5% and of major depression was 17.3%. The CESD cutoff with the best diagnostic accuracy was 18, with sensitivity 69% (95% confidence interval (CI) (51%, 87%)), specificity 83% ( 95% CI (74%, 92%)), positive predictive value (PPV) 60%, negative predictive value (NPV) 88%, + LR 4.14, and - LR 0.37. The best BDI cutoff was 14, with sensitivity 62% ( 95% CI (43%, 81%)), specificity 81% ( 95% CI ( 72%, 90%)), PPV 53%, NPV 85%, + LR 3.26, and - LR 0.47. Self-report scales have high +LR but low -LR for diagnosis of depression. When used for screening, the threshold for depression should be higher for ESRD compared with non-ESRD patients. Identifying depression using physician interview is important, given the low -LR of self- report scales.
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