a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
Aging Ment Health. 2019 Apr;23(4):507-514. doi: 10.1080/13607863.2017.1423037. Epub 2018 Feb 9.
Center of Epidemiologic Studies-Depression Scale (CES-D) provides a snapshot of symptom severity at a single point in time. However, the best way of using CES-D to classify long-term depression is unclear.
To identify long-term depression among HIV-infected and HIV-uninfected 50+ year-old men who have sex with men (MSM) with at least 5 years of follow-up, we compared sensitivities and specificities of CES-D-based metrics (baseline CES-D; four consecutive CES-Ds; group-based trajectory models) thresholded at 16 and 20 to a clinician's evaluation of depression phenotype based on all available data including CES-D history, depression treatment history, drug use history, HIV disease factors, and demographic characteristics.
A positive depressive phenotype prevalence was common among HIV-infected (prevalence = 33.1%) and HIV-uninfected MSM (prevalence = 23.2%). Compared to the depressive phenotype, trajectory models of CES-D≥20 provided highest specificities among HIV-infected (specificity = 99.9%, 95% Confidence Interval [CI]:99.4%-100.0%) and HIV-uninfected MSM (specificity = 99.0%, 95% CI:97.4%-99.7%). Highest sensitivities resulted from classifying baseline CES-D ≥ 16 among HIV-infected MSM (sensitivity = 75.0%, 95% CI:67.3%-81.7%) and four consecutive CES-Ds ≥ 16 among HIV-uninfected MSM (sensitivity = 81.0%, 95% CI:73.7%-87.0%).
Choice of method should vary, depending on importance of false positive or negative rate for long-term depression in HIV-infected and HIV-uninfected MSM.
中心流行病学研究抑郁量表（CES-D）提供了在单一时间点的症状严重程度的快照。然而，使用 CES-D 来分类长期抑郁的最佳方法尚不清楚。
为了在至少 5 年随访的感染和未感染 HIV 的 50 岁以上男男性行为者（MSM）中识别长期抑郁，我们比较了基于 CES-D 的指标（基线 CES-D；连续 4 个 CES-D；基于群组轨迹模型）的敏感性和特异性，这些指标的阈值为 16 和 20，与基于所有可用数据（包括 CES-D 病史、抑郁治疗史、药物使用史、HIV 疾病因素和人口统计学特征）评估的抑郁表型的临床医生评估结果相比较。
在感染和未感染 HIV 的 MSM 中，阳性抑郁表型的患病率均较高（感染 HIV 的 MSM 患病率=33.1%；未感染 HIV 的 MSM 患病率=23.2%）。与抑郁表型相比，CES-D≥20 的轨迹模型在感染 HIV 的 MSM（特异性=99.9%，95%置信区间[CI]：99.4%-100.0%）和未感染 HIV 的 MSM（特异性=99.0%，95% CI：97.4%-99.7%）中具有最高的特异性。感染 HIV 的 MSM 中基线 CES-D≥16 的分类敏感性最高（敏感性=75.0%，95% CI：67.3%-81.7%），未感染 HIV 的 MSM 中连续 4 个 CES-D≥16 的分类敏感性最高（敏感性=81.0%，95% CI：73.7%-87.0%）。
在感染和未感染 HIV 的 MSM 中，选择方法应根据长期抑郁的假阳性或假阴性率的重要性而有所不同。
