The utility of brief instruments for depression screening in dialysis patients
Isabel Vázquez, Adolfo Figueiras, Ángel Salgado-BarreiraAbstract
Background
Depression is a frequent but often underdiagnosed comorbid disorder in dialysis patients. The Beck Depression Inventory-Second Edition (BDI-II) is a reliable and valid instrument for depression screening but is relatively long for repeated use in clinical practice. The aim of this study was to compare the BDI-II with the shorter questionnaires Beck Depression Inventory-FastScreen (BDI-FS), the depression subscale of the Hospital Anxiety Depression Scale (HADS-D), the Mental Health (MH) scale of the SF-36 and two items of the MH (‘So down in the dumps that nothing could cheer you up’ and ‘Downhearted and blue’) to determine the most efficient instruments for screening depressive symptoms in dialysis patients.
Method
A cross-sectional study was conducted involving patients from 14 health centers undergoing in-center haemodialysis or peritoneal dialysis. All patients completed the BDI-II, HADS-D and the MH scale. The sensitivity, specificity, positive and negative predictive values for each brief instrument were assessed relative to the BDI-II ≥ 16.
Results
Of the 145 patients included in the study (mean age 62 years; 66% male) 24.8% had depressive symptoms (BDI ≥ 16). The cut-off points with the highest sensitivity and negative predictive value for BDI-FS were ≥ 3 (91.7% and 96.1%, respectively) and ≥ 4 (80.6% and 92.4%, respectively) and for the HADS-D were ≥ 4 (91.7% and 95.8%, respectively) and ≥ 5 (83.3% and 92.6%, respectively). The cut-off points for the total MH and the two items (considered separately or together) resulted in lower sensitivity (<80%) and lower negative predictive values (<90%).
Conclusions
Both BDI-FS and HADS-D are adequate screening tools for depression in the dialysis population. As the BDI-FS is easier to complete and correct and enables identification of patients at risk of suicide, it may be the best alternative to the BDI-II for depression screening in dialysis patients in clinical settings.