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Title: Clinical Utility of the Edmonton Symptom Assessment System to Screen for Depression and Anxiety in Kidney Transplant Recipients
Authors: E. Tang, S. Dano, A. Ayub, V. Li, I. Escudero, N. Ullah, N. Edwards, M. Novak, I. Mucsi
Year: 2019
Conference: American Transplant Congress, Canadian Society of Nephrology
Full Abstract* Control/Tracking Number: 19-A-2037-ATC Activity: Abstracts Current Date/Time: 11/30/2018 10:46:41 AM Clinical Utility Of The Edmonton Symptom Assessment System To Screen For Depression And Anxiety In Kidney Transplant Recipients Author Block E. Tang, S. Dano, A. Ayub, V. Li, I. Escudero, N. Ullah, N. Edwards, M. Novak, I. Mucsi; University Health Network, Toronto, ON, CANADA. Abstract: *Purpose: Anxiety and depression are frequent concerns in kidney transplant recipients and are associated with non-adherence and worse clinical outcomes. However, they are often underrecognized due to lack of inquiry. We have recently validated the Edmonton Symptom Assessment System-revised (ESASr) in kidney transplant recipients for symptoms assessment. Here we asses the measurement characteristics of ESASr to screen for anxiety and depression. *Methods: A cross-sectional sample of stable kidney transplant recipients completed legacy instruments (patient health questionnaire (PHQ-9) and generalized anxiety disorder (GAD-7)) and the ESASr. In this analysis we focused on the ESASr-A (anxiety) and ESASr-D (depression) items. The correlation between the legacy and ESASr scores was compared using spearman?s rho. Discrimination was assessed using receiver operating characteristic (ROC) analysis. We determined the cut-off to identify potential ?cases? that require further assessment using Youden?s J. We also constructed a Bayesian conditional probability plot integrating pre-test probability and likelihood ratios. *Results: Mean(?SD) age of the 270 participants was 51 (?16), 61% were male and 55% Caucasian. Spearman?s correlation between ESASr and the legacy questionnaires was moderately strong (ESASr-A/GAD-7: 0.64; ESASr-D/PHQ-9: 0.61). Good discrimination was found on ROC analysis (area under the curve ESASr-A 0.86; ESASr-D 0.82) (Figure 1.). From the ROC, the optimal cut off was ?4 for ESASr-A (Sensitivity = 0.75; Specificity = 0.86) and ?2 for ESASr-D (Sensitivity = 0.75; Specificity = 0.77). *Conclusions: ESAS-A and ESAS-D show good correlation with the respective legacy questionnaires. The identified cut-offs show good discrimination for moderate anxiety/depression (NPV and sensitivity). The findings may support the potential for ESASr use as an initial screening tool, with the ability to identify cases with only a few false negatives. Positive results can be paired with a second screening tool to identify true cases. : Author Disclosure Information: E. Tang: None. S. Dano: None. A. Ayub: None. V. Li: None. I. Escudero: None. N. Ullah: None. N. Edwards: None. M. Novak: None. I. Mucsi: None. Terms of Use Agreement (Complete): I have read and agree to the Terms of Use Agreement.: True Category (Complete): Kidney Psychosocial Keyword (Complete): Quality of life Questionnaire (Complete): Was the work presented in this abstract performed by an ASTS or AST accredited fellowship program?: No Has the primary or senior author of this abstract submission received a research award by ASTS or AST to support the investigator or the work?: No Please indicate if you would like to considered for an award: Not for consideration Please indicate your presentation preference: Poster or Oral Please state learning objective for your presentation: To demonstrate the clinical utility of the Edmonton Symptom Assessment System for screening of Anxiety and Depression in Kidney Transplant Recipients Please indicate your slide release authorization: I give permission to AST/ASTS/ATC to use one or more of my actual oral presentation slides and/or audio for educational purposes following the ATC. Does your study abide by the principles listed above?: Yes, my study abides by the principles listed above I attest that I will adhere to the following guidelines: Yes
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