Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Knowledge Institute of Medical Specialists, Utrecht, The Netherlands.
PLoS One. 2019 Jun 20;14(6):e0218512. doi: 10.1371/journal.pone.0218512. eCollection 2019.
Comorbid depression is common among patients with diabetes and has severe health consequences, but often remains unrecognized. Several questionnaires are used to screen for depression. A systematic review and meta-analysis regarding the diagnostic accuracy of depression questionnaires in adults with diabetes is unavailable. Our aim was to conduct a systematic review and meta-analysis to evaluate the diagnostic accuracy of depression questionnaires in adults with type 1 or type 2 diabetes.
PubMed, Embase and PsycINFO were searched from inception to 28 February 2018. Studies were included when the diagnostic accuracy of depression questionnaires was assessed in a diabetes population and the reference standard was a clinical interview. Data extraction was performed by one reviewer and checked by another. Two reviewers independently conducted the quality assessment (QUADAS-2). Diagnostic accuracy was pooled in bivariate random effects models. The main outcome was diagnostic accuracy, expressed as sensitivity and specificity, of depression questionnaires in an adult diabetes population. This study is reported according to PRISMA-DTA and is registered with PROSPERO (CRD42018092950).
A total 6,097 peer-reviewed articles were screened. Twenty-one studies (N = 5,703 patients) met the inclusion criteria for the systematic review. Twelve different depression questionnaires were identified, of which the CES-D (n = 6 studies) and PHQ-9 (n = 7 studies) were the most frequently evaluated. Risk of bias was unclear for multiple domains in the majority of studies. In the meta-analyses, five (N = 1,228) studies of the CES-D (≥16), five (N = 1,642) of the PHQ-9 (≥10) and four (N = 822) of the algorithm of the PHQ-9 were included in the pooled analysis. The CES-D (≥16) had a pooled sensitivity of 85.0% (95%CI, 71.3-92.8%) and a specificity of 71.6% (95%CI, 62.5-79.2%); the PHQ-9 (≥10) had a sensitivity of 81.5% (95%CI, 57.1-93.5%) and a specificity of 79.7% (95%CI, 62.1-90.4%). The algorithm for the PHQ-9 had a sensitivity of 60.9% (95%CI, 52.3-90.8%) and a specificity of 64.0% (95%CI, 53.0-93.9%).
This review indicates that the CES-D had the highest sensitivity, whereas the PHQ-9 had the highest specificity, although confidence intervals were wide and overlapping. The algorithm for the PHQ-9 had the lowest sensitivity and specificity. Given the variance in results and suboptimal reporting of studies, further high quality studies are needed to confirm the diagnostic accuracy of these depression questionnaires in patients with diabetes.
合并抑郁在糖尿病患者中很常见，对健康有严重影响，但往往未被识别。有几种问卷用于筛查抑郁。目前尚无关于糖尿病成人抑郁问卷诊断准确性的系统评价和荟萃分析。我们的目的是进行系统评价和荟萃分析，以评估 1 型或 2 型糖尿病成人中抑郁问卷的诊断准确性。
从建库到 2018 年 2 月 28 日，我们检索了 PubMed、Embase 和 PsycINFO。当评估糖尿病人群中抑郁问卷的诊断准确性且参考标准为临床访谈时，我们纳入了研究。由一名评审员进行数据提取，另一名评审员进行核对。两名评审员独立进行质量评估（QUADAS-2）。采用双变量随机效应模型汇总诊断准确性。主要结局为糖尿病成人人群中抑郁问卷的诊断准确性，以敏感度和特异度表示。本研究根据 PRISMA-DTA 进行报告，并在 PROSPERO（CRD42018092950）进行注册。
共筛选出 6097 篇同行评议文章。21 项研究（N=5703 例患者）符合系统评价的纳入标准。确定了 12 种不同的抑郁问卷，其中 CES-D（n=6 项研究）和 PHQ-9（n=7 项研究）评估最频繁。大多数研究的多个领域的偏倚风险不明确。在荟萃分析中，5 项 CES-D（≥16）（N=1228）、5 项 PHQ-9（≥10）（N=1642）和 4 项 PHQ-9 算法（N=822）的研究被纳入汇总分析。CES-D（≥16）的合并敏感度为 85.0%（95%CI，71.3-92.8%），特异度为 71.6%（95%CI，62.5-79.2%）；PHQ-9（≥10）的敏感度为 81.5%（95%CI，57.1-93.5%），特异度为 79.7%（95%CI，62.1-90.4%）。PHQ-9 算法的敏感度为 60.9%（95%CI，52.3-90.8%），特异度为 64.0%（95%CI，53.0-93.9%）。
本综述表明，CES-D 的敏感度最高，而 PHQ-9 的特异度最高，尽管置信区间较宽且有重叠。PHQ-9 算法的敏感度和特异度最低。鉴于研究结果的差异和报告的不充分，需要进一步开展高质量研究来证实这些糖尿病患者抑郁问卷的诊断准确性。
