Member's paper - Kidney Health Education and Research Group

Abstract

Evaluating PROMIS-57 Domains To Screen For Anxiety And Depression Using Legacy Instruments Among Kidney Transplant Recipients

Aarushi Bansal1, Oladapo Ekundayo1, Evan Tang1, Farzad Khalafi1, Heather Ford1, Madeline Li3, Marta Novak2, Istvan Mucsi1

2018

American Transplant Congress

Full Abstract
BACKGROUND Depression and anxiety are frequent among kidney transplant recipients (KTRs). We evaluate the accuracy of the Patient Reported Outcomes Measurement System (PROMIS 57 item) depression and anxiety domains among KTRs. METHODS Participants of this cross-sectional, convenience sample of stable KTRs completed the PROMIS-57, GAD-7 and PHQ-9 questionnaires. Raw scores of legacy tools were converted to PROMIS T-scores using PROsetta Stone? crosswalk files. A cut off score of 10 on GAD-7 and PHQ-9 was used to indicate clinically significant depression or anxiety, respectively. Corresponding PROsetta stone cut offs on the reported PROMIS57 scales were used to categorize depression and anxiety. We computed the sensitivity, specificity, positive predictive and negative predictive values. Cohens Kappa was used to assess degree of agreement between legacy and respective PROMIS domains to assign patients to ?depression? and ?anxiety? categories. Receiver operating characteristic (ROC) curves were used to determine the best cut off of ?reported? PROMIS57 scores to identify anxiety and depression. RESULTS Our sample included 150 KTRs mean (SD) age was 50 (17) years, 57% male, 57% white. Based on legacy tools, 7% had moderate to severe anxiety and 8% had depression while reported PROMIS57 scores yielded 9% with anxiety and 11% with depression. Calculated anxiety and depression scores showed strong correlations with reported PROMIS-57 anxiety and depression scores, respectively. PROMIS values corresponding to legacy cut offs for severe to moderate anxiety and depression had high specificity (anx=0.95, dep=0.93) and moderate sensitivity (anx=0.70, dep=0.58). Kappa values indicated moderate agreement between GAD7 categorization of anxiety versus PROMIS57 (K=0.55). Similarly, there was moderate agreement between PHQ-9 classification of depression versus PROMIS-57 (K=0.45). The area under the ROC curves for PROMIS-57 with GAD-7 and PHQ-9 categorization, respectively, were all above 0.90. CONCLUSIONS The PROMIS-57 depression and anxiety domains are valid self-report tools to assess depressive and anxiety symptoms among KTRs.

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