A comparison of multiple patient reported outcome measures in identifying major depressive disorder in people with multiple sclerosis.

TitleA comparison of multiple patient reported outcome measures in identifying major depressive disorder in people with multiple sclerosis.
Publication TypeJournal Article
2015
AuthorsAmtmann D, Bamer AM, Johnson KL, Ehde DM, Beier ML, Elzea JL, Bombardier CH
JournalJ Psychosom Res
Volume79
Issue6
Pagination550-7
Date Published2015 Dec
ISSN1879-1360

BACKGROUND: Depression is one of the most prominent and debilitating symptoms in individuals with multiple sclerosis (MS), yet there is currently no consensus on the best instruments for depression screening in MS. More head to head comparisons of available screening instruments are needed to advise MS researchers and clinicians. METHODS: A cross-sectional comparison of the effectiveness of screening for MDD using multiple patient reported outcome (PRO) screeners against a modified SCID telephone interview was completed in 164 individuals with MS. Stratum goals were set for depression levels to ensure participation by people with borderline and higher levels of depression. Criterion standard was a modified SCID MDD module. PRO measures included the PHQ-9, BDI-FS, PROMIS depression, Neuro-QOL depression, M-PHQ-2, PHQ-2, and CESD. RESULTS: 48 (29%) individuals met the modified SCID criteria for MDD. The sensitivity of the PRO measures ranged from 60% to 100% while specificity ranged from 46% to 86%. The ROC area for the PRO measures ranged from 0.79 to 0.83. Revised (higher) cutoff scores were suggested by the ROC analyses for most self-reported screeners. LIMITATIONS: Enrollment was stopped early because of difficulties with recruitment. Several SCID recording could not be reviewed and diagnosis confirmed. CONCLUSIONS: CESD-10 and PHQ9 had the best diagnostic performance using optimal cutoffs, but no one PRO measure stood out as significantly better than any other. Even when revised cutoff scores were used, none of the self-reported screeners identified people with MDD with adequate accuracy. More accurate self-reported screeners would facilitate diagnosing of MDD for both research and clinical purposes.
10.1016/j.jpsychores.2015.08.007
Full Text

What was this research about?

Depression is a common problem among people with multiple sclerosis (MS) that can lead to poor health and quality of life. People with MS tend to be under-treated for depression. In order to provide proper treatment, we need an accurate way to find out if someone is experiencing low mood.  In clinics, we screen for depression by looking at responses to questions like: How often have you been bothered by feeling down? There are many questionnaires that can be used to screen for depression. The best questionnaire correctly identifies people with depression without flagging those who do not need treatment for depression. In this research, we compared six depression questionnaires to a standard clinical interview commonly used to diagnose depression.  We wanted to see which questionnaire was the best indicator that someone living with MS was feeling depressed and should be referred for evaluation or treatment.


What did the researchers do?

We enrolled about 160 people with MS with differing levels of depression. The six depression questionnaires were mailed to participants. Then, after completing the surveys, the participants completed a clinical interview by phone with the research assistant. These interviews were audio-recorded, and a therapist with depression expertise made a diagnosis based on the recorded interviews. We compared the survey answers with the expert diagnoses to see which questionnaire most closely matched the interview diagnosis.


What did the researchers find?

About 30% of the participants were found have depression by the clinical interview. None of the questionnaires stood out as clearly the best. All questionnaires flagged too many of the participants who were not depressed as having depression.  While all of the questionnaires over-diagnosed depression in people with MS, the Center for Epidemiologic Studies Depression Scale-10 (CESD-10) and the Patient Health Questionnaire-9 (PHQ-9) overlapped most with the therapist diagnoses.


How can you use this research?

Current depression questionnaires are not as accurate as they could be in identifying people with MS who experience depression. A new screening tool may need to be developed to improve accuracy of depression screening, perhaps by combining questions across some of the existing tools.


Things you should know:

If you suspect that you or a loved one may be feeling depressed, take a look at our fact sheet on How to Cope with Depression.

Original Research Article:

Amtmann D, Bamer AM, Johnson KL, Ehde DM, Beier ML, Elzea JL, Bombardier CH. A comparison of multiple patient reported outcome measures in identifying major depressive disorder in people with multiple sclerosis. J Psychosom Res. 2015; 79:550-7.
PubMed ID26363679