Prognostic Utility of a Self-Reported Depression Questionnaire versus Clinician-Based Assessment on Renal Outcomes

Abstract

Background: The prognostic utility of self-administered depression scales in chronic kidney disease (CKD) independent of a clinician-based major depressive disorder (MDD) diagnosis is neither clearly established nor are the optimal cutoff scores for predicting outcomes. The overlap between symptoms of depression and chronic disease raises the question of whether a cutoff score on a depression scale can be substituted for a time-consuming diagnostic interview to prognosticate risk. Methods: The 16-item Quick Inventory of Depression Symptomatology-Self Report scale (QIDS-SR₁₆) was administered to 266 consecutive outpatients with non-dialysis CKD, followed prospectively for 12 months for an apriori composite outcome of death or dialysis or hospitalization. Association of QIDS-SR₁₆ best cutoff score, determined by receiver/responder operating characteristics curves, with outcomes was investigated using survival analysis. The effect modification of an interview-based clinician MDD diagnosis on this association was ascertained. Results: There were 126 composite events. A QIDS-SR₁₆ cutoff ≥8 had the best prognostic accuracy, hazards ratio (HR) = 1.77, 95% CI 1.24-2.53, p = 0.002. This cutoff remained significantly associated with outcomes even after controlling for comorbidities, estimated glomerular filtration rate, hemoglobin and serum albumin, adjusted HR (aHR) = 1.80, 95% CI 1.23-2.62, p = 0.002, and performed similarly to a clinician-based MDD diagnosis (aHR = 1.72, 95% CI 1.14-2.68). Adjustment for MDD conferred the association of QIDS-SR₁₆ with outcomes no longer significant. Conclusions: QIDS-SR₁₆ cutoff ≥8 adds to the prognostic information available to practicing nephrologists during routine clinic visits from comorbidities and laboratory data. This cutoff score performs similar to a clinician diagnosis of MDD and provides a feasible and time-saving alternative to an interview-based MDD diagnosis for determining prognosis in CKD patients.

Effect of Sertraline on Depressive Symptoms in Patients With Chronic Kidney Disease Without Dialysis Dependence

“…This instrument was previously validated for depression screening and shown to be independently associated with outcomes among individuals with CKD. 16,17 …”

Fatigue in Nondialysis Chronic Kidney Disease: Correlates and Association with Kidney Outcomes

“…The QIDS-SR 16 has 16 items based on the 9 symptom domains of MDD, with a score range of 0-27, and takes 5-10 min to complete [11][12][13]. The BDI-I has 21 items with a score ranging from 0 to 63.…”

“…Several complex clinical factors, some of which may be modifiable, correlate with fatigue in patients with CKD-D, including higher burden of medical comorbidities, sedentary lifestyle, obesity, hypoalbuminemia, and use of sleeping medications [4,[8][9][10]. Fatigue can be easily measured using self-reported patient questionnaires, such as the 16-item Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR 16 ) scale [11][12][13], the Beck Depression Inventory-I (BDI-I) [13,14], or the 12-Item short form 12 health survey (SF-12) scale [15]. However, one limitation of prior studies of fatigue in CKD-D patients is the use of several different self-report scales across studies, so it is not known which one of these scales most reliably determines the presence of clinically relevant fatigue [16].…”

Interleukin 1 Beta Is Associated With Depression in Multiple Sclerosis Patients

“…This exclusion affects the patient in more than one aspect. A proper diagnosis of depression would allow proper treatment, and as mentioned before, depression affects prognosis in diseases such as Rheumatoid Arthritis [26], Chronic Kidney Disease [27], type 2 diabetes [28], irritable bowel syndrome [29], and Multiple Sclerosis [18].…”