The predictive value of self-report scales compared with physician diagnosis of depression in hemodialysis patients

• Published in: Kidney international Vol. 69; no. 9; pp. 1662 - 1668
• Main Authors: Hedayati, S.S., Bosworth, H.B., Kuchibhatla, M., Kimmel, P.L., Szczech, L.A.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2006; Nature Publishing; Elsevier Limited
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cohort Studies; depression; Depression - complications; Depression - diagnosis; Depression - epidemiology; dialysis; Emergency and intensive care: renal failure. Dialysis management; Female; Humans; Intensive care medicine; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Prevalence; Prognosis; Psychiatric Status Rating Scales; Renal Dialysis - psychology; sensitivity; specificity; dialysis; specificity; depression; sensitivity; Mood disorder; Human; Nephrology; Self evaluation; Depressions; Hemodialysis; Physician; Depression; Urology; Extrarenal dialysis; Sensitivity; Specificity; Predictive value; Dialysis; Diagnosis; Comparative study
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1038/sj.ki.5000308

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.