Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Soroti District Local Government Health Department, Uganda.
PLoS One. 2022 Jun 29;17(6):e0270175. doi: 10.1371/journal.pone.0270175. eCollection 2022.
Depression is rarely screened for among People Living with Human Immunodeficiency Virus (PLHIV) although it is 2 to 3 times more prevalent among PLHIV than in the general population. In instances where depression is screened for using screening tools, it usually follows noticing depression risk factors. This practice of selectively screening for depression could be leaving some cases of depression unattended to. On the other hand, subjecting every client to screening tools (non-selective screening) offers every patient an opportunity to be managed for depression. However, this could require additional resources as compared to selective screening. We present and discuss results on whether non-selective and selective screening strategies differ in depression case detection, and in addition, we also present perceptions of the stake holders on the two screening strategies.
The study was conducted in Princess Diana Memorial Health Centre IV HIV clinic using a randomized controlled trial with a qualitative component. To determine whether there was a difference in depression case detection, consecutively sampled participants were randomly allocated to either non-selective or selective screening strategy. Participants allocated to selective screening were screened for depression using the patient health questionnaire (s) (PHQs) if they were at "crisis points". While those allocated to non-selective screening were screened regardless of whether the "crisis points" were noticed or not. The PHQ-2 and PHQ-9 were used in sequence. 326 PLHIV participated in the study. Outcomes of the MINI evaluation were analyzed for those with PHQ-9 scores of 10 or more to confirm major depressive disorder (MDD). Data was analyzed using the two sample Z-test for proportions with Stata 2013 software. To explore the perceptions of the stake holders, key informant interviews were performed with six stakeholders that experienced the study.
Cases of depression (PHQ-9 score ≥ 5) were more likely to be detected by the non-selective screening strategy 30.2% (49/162) compared to the selective screening strategy 19.5% (32/164) (difference in proportions 0.107, 95% confidence interval 0.014-0.200, Cohen's h = 0.25, P = 0.03). The stake holders thought it was important to screen for depression among PLHIV with preference to non-selective screening strategy.
Evidence from this data suggests that more cases of depression (PHQ-9 score ≥ 5) are likely to be detected with non-selective screening as opposed to selective screening.
PACTR201802003141213 (name: comparison of routine versus selective screening for depression strategies among PLHIV attending Princess Diana Memorial Health Centre iv Soroti).
尽管艾滋病毒感染者（PLHIV）中抑郁症的发病率比普通人群高 2 到 3 倍，但很少对其进行筛查。在使用筛查工具筛查抑郁症的情况下，通常是在注意到抑郁症风险因素后进行。这种有选择性地筛查抑郁症的做法可能会忽略一些抑郁症病例。另一方面，对每个患者进行筛查工具（非选择性筛查）会为每个患者提供管理抑郁症的机会。但是，与选择性筛查相比，这可能需要额外的资源。我们提出并讨论了非选择性和选择性筛查策略在抑郁症病例检测方面是否存在差异的结果，此外，我们还介绍了利益相关者对这两种筛查策略的看法。
该研究在Princess Diana Memorial Health Centre IV HIV 诊所进行，采用随机对照试验和定性部分。为了确定在抑郁症病例检测方面是否存在差异，连续抽样的参与者被随机分配到非选择性或选择性筛查策略。如果处于“危机点”，分配到选择性筛查的参与者将使用患者健康问卷（PHQ-s）筛查抑郁症。而那些被分配到非选择性筛查的参与者则不论是否注意到“危机点”都进行筛查。PHQ-2 和 PHQ-9 依次使用。326 名 PLHIV 参加了这项研究。使用 MINI 评估分析 PHQ-9 得分≥10 的患者的结果，以确认是否患有重度抑郁症（MDD）。使用 Stata 2013 软件对二项样本 Z 检验进行数据分析。为了探讨利益相关者的看法，对经历过该研究的六位利益相关者进行了关键知情人访谈。
非选择性筛查策略更有可能检测到抑郁症病例（PHQ-9 得分≥5），占 30.2%（49/162），而选择性筛查策略占 19.5%（32/164）（比例差异 0.107，95%置信区间 0.014-0.200，Cohen's h=0.25，P=0.03）。利益相关者认为对 PLHIV 进行抑郁症筛查很重要，首选非选择性筛查策略。
本数据表明，与选择性筛查相比，非选择性筛查更有可能检测到更多的抑郁症病例（PHQ-9 得分≥5）。
PACTR201802003141213（名称：在 Soroti 的 Princess Diana Memorial Health Centre IV 艾滋病毒感染者中比较常规与选择性筛查抑郁症策略）。
