Vázquez Isabel, Figueiras Adolfo, Salgado-Barreira Ángel
Department of Clinical Psychology and Psychobiology, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
Department of Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.
Clin Kidney J. 2024 Nov 22;18(1):sfae369. doi: 10.1093/ckj/sfae369. eCollection 2025 Jan.
Depression is a frequent but often underdiagnosed comorbid disorder in dialysis patients. The Beck Depression Inventory-Second Edition (BDI-II) is a reliable and valid instrument for depression screening but is relatively long for repeated use in clinical practice. The aim of this study was to compare the BDI-II with the shorter questionnaires Beck Depression Inventory-FastScreen (BDI-FS), the depression subscale of the Hospital Anxiety Depression Scale (HADS-D), the Mental Health (MH) scale of the 36-item Short Form Health Survey (SF-36) and two items of the MH ('So down in the dumps that nothing could cheer you up' and 'Downhearted and blue') to determine the most efficient instruments for screening depressive symptoms in dialysis patients.
A cross-sectional study was conducted involving patients from 14 health centres undergoing in-centre haemodialysis or peritoneal dialysis. All patients completed the BDI-II, HADS-D and MH scale. The sensitivity, specificity and positive and negative predictive values for each brief instrument were assessed relative to BDI-II ≥16.
Of the 145 patients included in the study (mean age 62 years; 66% male), 24.8% had depressive symptoms (BDI ≥16). The cut-off points with the highest sensitivity and negative predictive value for BDI-FS were ≥3 (91.7% and 96.1%, respectively) and ≥4 (80.6% and 92.4%, respectively) and for the HADS-D these were ≥4 (91.7% and 95.8%, respectively) and ≥5 (83.3% and 92.6%, respectively). The cut-off points for the total MH and the two items (considered separately or together) resulted in lower sensitivity (<80%) and lower negative predictive values (<90%).
Both the BDI-FS and HADS-D are adequate screening tools for depression in the dialysis population. As the BDI-FS is easier to complete and score and enables identification of patients at risk of suicide, it may be the best alternative to the BDI-II for depression screening in dialysis patients in clinical settings.
抑郁症是透析患者中常见但常被漏诊的共病性疾病。贝克抑郁量表第二版（BDI-II）是一种可靠且有效的抑郁症筛查工具，但在临床实践中反复使用相对耗时。本研究的目的是比较BDI-II与较短的问卷，即贝克抑郁快速筛查量表（BDI-FS）、医院焦虑抑郁量表（HADS）的抑郁分量表（HADS-D）、36项简短健康调查（SF-36）的心理健康（MH）量表以及MH量表中的两个条目（“情绪低落以至于没有什么能让你振作起来”和“垂头丧气、情绪低落”），以确定筛查透析患者抑郁症状的最有效工具。
开展一项横断面研究，纳入来自14个健康中心接受中心血液透析或腹膜透析的患者。所有患者均完成BDI-II、HADS-D和MH量表评估。相对于BDI-II≥16，评估各简短工具的敏感性、特异性以及阳性和阴性预测值。
本研究纳入的145例患者（平均年龄62岁；66%为男性）中，24.8%有抑郁症状（BDI≥16）。BDI-FS的截断点中，敏感性和阴性预测值最高的分别是≥3（分别为91.7%和96.1%）以及≥4（分别为80.6%和92.4%）；HADS-D的截断点中，敏感性和阴性预测值最高的分别是≥4（分别为91.7%和95.8%）以及≥5（分别为83.3%和92.6%）。总MH量表以及两个条目的截断点（单独或合并考虑）敏感性较低（<80%）且阴性预测值较低（<90%）。
BDI-FS和HADS-D都是透析人群抑郁症的合适筛查工具。由于BDI-FS填写和计分更简便，且能够识别有自杀风险的患者，在临床环境中，它可能是BDI-II用于透析患者抑郁症筛查的最佳替代工具。
