Clinical utility of the Montgomery-Åsberg Depression Rating Scale for the detection of depression among bariatric surgery candidates

• Published in: BMC psychiatry 2016-04, Vol.16, p.119-119, Article 119
• Main Authors: Duarte-Guerra, Leorides Severo, Gorenstein, Clarice, Paiva-Medeiros, Paula Francinelle, Santo, Marco Aurélio, Lotufo Neto, Francisco, Wang, Yuan-Pang
• Format: Article
• Language: English
• Subjects: Adult; Bariatric Surgery - adverse effects; Brazil; Depression - diagnosis; Depression - etiology; Depressive Disorder - diagnosis; Divorce; Female; Gastrointestinal surgery; Humans; Male; Marital status; Mental depression; Mental Health - statistics & numerical data; Middle Aged; Obesity; Patients; Population; Psychiatric Status Rating Scales; Psychiatry; Psychopathology; Quantitative psychology; Reproducibility of Results; ROC Curve; Sensitivity and Specificity; Validity; Weight control
• ISSN: 1471-244X; 1471-244X
• DOI: 10.1186/s12888-016-0823-8

Clinical assessment of depression is an important part of pre-surgical assessment among individuals with morbid obesity. However, there is no agreed-upon instrument to identify mood psychopathology in this population. We examined the reliability and criterion validity of the clinician-administered Montgomery-Åsberg Depression Rating Scale (MADRS) and the utility of a short version for bariatric surgery candidates. The sample was 374 patients with obesity, consecutively recruited from the waiting list of a bariatric surgery clinic of University Hospital, Brazil: women 80%, mean BMI 47 kg/m(2), mean age 43.0 years. The 10-item MADRS was analyzed against the SCID-I. Items that showed small relevance to sample's characteristics and contribution to data variability were removed to develop the short 5-item version of scale. We calculated the sensitivity and specificity of cutoff points of both versions MADRS, and values were plotted as a receiver operating characteristic curve. For the 10-item MADRS, the Cronbach's alpha coefficient was 0.93. When compared against SCID-I, the best cut-off threshold was 13/14, yielding sensitivity of 0.81 and specificity 0.85. Following items were removed: reduced appetite, reduced sleep, concentration difficulties, suicide thought and lassitude. The 5-item version showed an alpha coefficient of 0.94 and a best cut-off threshold of 10/11, yielding sensitivity of 0.81 and specificity 0.87. Similar overall ability to discriminate depression of almost 90% was found for both 10-item and 5-item MADRS. The MADRS is a reliable and valid instrument to assess depressive symptoms among treatment-seeking bariatric patients. Systematic application of the abbreviated version of the MADRS can be recommended for enhancing the clinical detection of depression during perioperative period.