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Two-step screening for depressive symptoms in patients treated with kidney replacement therapies - cross-sectional analysis


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Date
2021

Authors
Dano S, Lan HH, Macanovic S, Bartlett S, Howell D, Li M, Hanmer J, Peipert JD, Novak M, Mucsi I.

Subject
Two-step screening for depressive symptoms in patients treated with kidney replacement therapies - cross-sectional analysis

Abstract
Background: Systematic screening for depressive symptoms may identify patients who may benefit from clinical assessment and psychosocial support. Here we assess a 2-step screening using ultra-brief pre-screeners (Edmonton Symptom Assessment Survey-revised Depression Item [ESASr-D] or Patient Health Questionnaire-2 [PHQ-2]) followed by the Patient Reported Outcomes Measurement Information System Depression questionnaire [PROMIS-D] to identify depressive symptoms in patients on kidney replacement therapies. Methods: Cross-sectional study of adults (kidney transplant recipients or treated with dialysis) in Toronto, Canada. We simulated various 2-step screening scenarios where only patients above a pre-screening cut-off score on ESASr-D or PHQ-2 would move onto step 2 (PROMIS-D). Screening performance was evaluated by sensitivity, specificity, positive and negative predictive values (PPV and NPV), using Patient Health Questionnaire-9 (PHQ-9) as the referent. The average number of items completed by patients in different scenarios is reported. Results: Of 480 participants, 60% were male, mean age was 55 years. Based on PHQ-9, 19% of patients had moderate/severe depressive symptoms. Pre-screening with PHQ-2 ≥1 combined with PROMIS-D ≥53 provided the best 2-step results (sensitivity:0.81, specificity:0.84, NPV:0.95). Two-step screening also reduces question burden. Conclusions: A 2-step screening using PHQ-2 ≥1 followed by PROMIS-D ≥53 has good sensitivity and specificity for identifying potentially significant depressive symptoms among patients on kidney replacement therapies. This approach has lower question burden. Screened-in patients will need further clinical assessment to establish diagnosis.