Ajmera Transplant Center, University Health Network, Toronto, ON, Canada.
Centre for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, QC, Canada.
Nephrol Dial Transplant. 2023 May 4;38(5):1318-1326. doi: 10.1093/ndt/gfac262.
Systematic screening for depressive symptoms may identify patients who may benefit from clinical assessment and psychosocial support. Here we assess a two-step screening using ultrabrief 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.
We conducted a cross-sectional study of adults (kidney transplant recipients or treated with dialysis) in Toronto, ON, Canada. We simulated various two-step screening scenarios where only patients above a pre-screening cut-off score on the ESASr-D or PHQ-2 would move to step 2 (PROMIS-D). Screening performance was evaluated by sensitivity, specificity and positive and negative predictive values using the Patient Health Questionnaire-9 (PHQ-9) as the referent. The average number of items completed by patients in different scenarios was reported.
Of 480 participants, 60% were male with a mean age of 55 years. Based on PHQ-9, 19% of patients had moderate or severe depressive symptoms. Pre-screening with a PHQ-2 score ≥1 combined with a PROMIS-D score of ≥53 provided the best two-step results (sensitivity 0.81, specificity 0.84, NPV 0.95). Two-step screening also reduces question burden.
A two-step screening using a PHQ-2 score ≥1 followed by a PROMIS-D score ≥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 a diagnosis.
系统的抑郁症状筛查可能会发现需要进行临床评估和心理社会支持的患者。在这里，我们评估了两步筛查方法，即使用超简短预筛器[埃德蒙顿症状评估调查修订版抑郁条目（ESASr-D）或患者健康问卷-2（PHQ-2）]进行初步筛查，然后使用患者报告的结局测量信息系统抑郁问卷（PROMIS-D）来识别接受肾脏替代治疗的患者中的抑郁症状。
我们在加拿大安大略省多伦多市进行了一项横断面研究，纳入成年患者（肾移植受者或透析治疗者）。我们模拟了各种两步筛查方案，只有在 ESASr-D 或 PHQ-2 的预筛查截断值以上的患者才会进入第二步（PROMIS-D）。使用患者健康问卷-9（PHQ-9）作为参考，通过敏感性、特异性以及阳性和阴性预测值来评估筛查性能。报告了不同方案中患者完成的平均项目数。
在 480 名参与者中，60%为男性，平均年龄为 55 岁。根据 PHQ-9，19%的患者有中度或重度抑郁症状。PHQ-2 评分≥1 结合 PROMIS-D 评分≥53 的预筛查提供了最佳的两步筛查结果（敏感性 0.81，特异性 0.84，NPV 0.95）。两步筛查还降低了问题负担。
使用 PHQ-2 评分≥1 进行初步筛查，然后使用 PROMIS-D 评分≥53 进行两步筛查，可以很好地识别接受肾脏替代治疗的患者中可能存在的显著抑郁症状，具有较高的敏感性和特异性。这种方法的问题负担较低。筛查出的患者需要进一步的临床评估来确定诊断。
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