Development and Preliminary Validation of a Depression Assessment Tool for Maintenance Hemodialysis Patients

Abstract

Patients undergoing maintenance hemodialysis (MHD) are subject to a higher-than-usual prevalence of depressive disorders. However, the lack of consensus regarding the best assessment method remains an important problem. Thus, there is a clear need for more effective screening tools and an easily administered, disease-specific self-report measure of depression in MHD patients. After we developed and administered an initial depression inventory for MHD patients (I-DI-MHD), we created the DI-MHD and administered the DI-MHD and the Beck Depression Inventory (BDI) to 354 patients from four hospitals. Reliability, construct validity and receiver operator characteristic curves were assessed. The 17-item DI-MHD instrument displayed good internal consistency (Cronbach's alpha =0.893), provided excellent convergent validity, and correlated with the BDI scale (kappa =0.785, P <0.001). A factor analysis pattern matrix analysis showed that a four-factor model provided the best account of the data. Finally, the DI-MHD cutoff yielded a sensitivity of 0.97 and a specificity of 0.86, which were slightly better than the corresponding values for the BDI. The DI-MHD scale shows reasonable validity and reliability for assessing depression in MHD patients.

Depression Screening Tools for Patients with Kidney Failure

“…Other tools include the Cognitive Depression Index (CDI) (15), the Center for Epidemiologic Studies-Depression Scale (CES-D) (16), the Hospital Anxiety and Depression Scale-Depressive Subscale (HADS-D) (17), the Geriatric Depression Scale 15 (GDS-15) (18,19), the Hamilton Depression Rating Scale (20), the Patient Health Questionnaire 9 (PHQ-9) (21), and others. We identified only one study of a depression tool specifically targeting patients on maintenance dialysis (Depression Inventory-Maintenance Hemodialysis [DI-MHD]) (22). Supplemental Table 3 and Table 1 provide study characteristics and Table 2 provides a brief description of the included tools and the gold standard interviews used as reference standards.…”

“…There were five US studies (24,33,35,37,46). Other studies were located in Australia (25), Canada (27), China (22), Italy (29), The Netherlands (30,36), Norway (34), Saudi Arabia (23), Turkey (28), and the United Kingdom (26,30).…”

“…Seven studies examined thresholds for major depressive disorder (23)(24)(25)(26)30,33,37), one of which also categorized less severe depression (23). The remaining nine studies did not describe differences between major depressive disorder, less severe depressive disorders (e.g., dysthymia, pervasive depressive disorder), and subclinical symptoms (Supplemental Table 3) (22,(27)(28)(29)31,32,(34)(35)(36).…”

“…Among studies screening for depressive symptoms and disorders ranging from subclinical to major depressive disorder (22,31,32,34), sample sizes ranged from 43 (26) to 319 (22). Only one study (n598) was conducted in the United States (31).…”

“…At a threshold of $14, sensitivity was 0.62, specificity was 0.81, and AUC was 0.77 (31). The largest study (n5319), conducted in China, compared the BDI-II ($19) to the Structured Clinical Interview for DSM-IV as part of a development and validation study for a depression screen designed specifically for patients undergoing maintenance hemodialysis (22). Sensitivity, specificity, positive predictive value, negative predictive value, and AUC were 0.83, 0.86, 0.63, 0.94, and 0.84, respectively.…”