Two-step screening for depressive symptoms in patients treated with kidney replacement therapies: a cross-sectional analysis

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2023-05, Vol.38 (5), p.1318-1326
• Main Authors: Dano, Sumaya, Lan, Haoyue Helena, Macanovic, Sara, Bartlett, Susan, Howell, Doris, Li, Madeline, Hanmer, Janel, Peipert, John Devin, Novak, Marta, Mucsi, Istvan
• Format: Article
• Language: English
• Subjects: Adult; Cross-Sectional Studies; Depression - diagnosis; Depression - etiology; Depression - psychology; Female; Humans; Male; Mass Screening; Middle Aged; Original; Renal Dialysis; Renal Replacement Therapy; Reproducibility of Results; Surveys and Questionnaires
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfac262

ABSTRACT Background 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. Methods 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. Results 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. Conclusions 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. Graphical Abstract Graphical Abstract