Gill Stephanie J, Lukmanji Sara, Fiest Kirsten M, Patten Scott B, Wiebe Samuel, Jetté Nathalie
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
Epilepsia. 2017 May;58(5):695-705. doi: 10.1111/epi.13651. Epub 2017 Jan 8.
Depression affects approximately 25% of epilepsy patients. However, the optimal tool to screen for depression in epilepsy has not been definitively established. The purpose of this study was to systematically review the literature on the validity of depression-screening tools in epilepsy.
MEDLINE, EMBASE, and PsycINFO were searched until April 4, 2016 with no restriction on dates. Abstract, full-text review and data abstraction were conducted in duplicate. We included studies that evaluated the validity of depression-screening tools and reported measures of diagnostic accuracy (e.g., sensitivity, specificity, and negative and positive predictive values) in epilepsy. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies Version 2. Medians and ranges for estimates of diagnostic accuracy were calculated when appropriate.
A total of 16,070 abstracts were screened, and 38 articles met eligibility criteria. Sixteen screening tools were validated in 13 languages. The most commonly validated screening tool was the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) (n = 26). The Mini International Neuropsychiatric Interview (MINI) (n = 19) was the most common reference standard used. At the most common cutpoint of >15 (n = 12 studies), the NDDI-E had a median sensitivity of 80.5% (range 64.0-100.0) and specificity of 86.2 (range 81.0-95.6). Meta-analyses were not possible due to variability in cutpoints assessed, reference standards used, and lack of confidence intervals reported.
A number of studies validated depression screening tools; however, estimates of diagnostic accuracy were inconsistently reported. The validity of scales in practice may have been overestimated, as cutpoints were often selected post hoc based on the study sample. The NDDI-E, which performed well, was the most commonly validated screening tool, is free to the public, and is validated in multiple languages and is easy to administer, although selection of the best tool may vary depending on the setting and available resources.
抑郁症影响约25%的癫痫患者。然而，尚未明确确定用于筛查癫痫患者抑郁症的最佳工具。本研究的目的是系统回顾关于癫痫患者抑郁症筛查工具有效性的文献。
检索MEDLINE、EMBASE和PsycINFO直至2016年4月4日，对日期无限制。摘要、全文审查和数据提取均进行了两次。我们纳入了评估抑郁症筛查工具有效性并报告癫痫诊断准确性指标（如敏感性、特异性以及阴性和阳性预测值）的研究。使用诊断准确性研究质量评估第2版对研究质量进行评估。在适当情况下计算诊断准确性估计值的中位数和范围。
共筛选了16,070篇摘要，38篇文章符合纳入标准。16种筛查工具在13种语言中得到验证。最常被验证的筛查工具是癫痫神经疾病抑郁量表（NDDI-E）（n = 26）。使用最频繁的参考标准是迷你国际神经精神访谈（MINI）（n = 19）。在最常见的切点>15时（n = 12项研究），NDDI-E的中位数敏感性为80.5%（范围64.0 - 100.0），特异性为86.2（范围81.0 - 95.6）。由于评估的切点、使用的参考标准存在差异以及未报告置信区间，无法进行荟萃分析。
多项研究验证了抑郁症筛查工具；然而，诊断准确性的估计报告不一致。由于切点通常是根据研究样本事后选择的，量表在实际中的有效性可能被高估了。表现良好的NDDI-E是最常被验证的筛查工具，对公众免费，在多种语言中得到验证且易于实施，尽管最佳工具的选择可能因环境和可用资源而异。
