A comparison of nine scales to detect depression in Parkinson disease: which scale to use?

Abstract

Objective: The Methods of Optimal Depression Detection in Parkinson's Disease (MOOD-PD) study compared the psychometric properties of 9 depression scales to provide guidance on scale selection in Parkinson disease (PD).

Methods: Patients with PD (n = 229) from community-based neurology practices completed 6 self-report scales (Beck Depression Inventory [BDI]-II, Center for Epidemiologic Studies Depression Rating Scale-Revised [CESD-R], 30-item Geriatric Depression Scale [GDS-30], Inventory of Depressive Symptoms-Patient [IDS-SR], Patient Health Questionnaire-9 [PHQ-9], and Unified Parkinson's Disease Rating Scale [UPDRS]-Part I) and were administered 3 clinician-rated scales (17-item Hamilton Depression Rating Scale [HAM-D-17], Inventory of Depressive Symptoms-Clinician [IDS-C], and Montgomery-Åsberg Depression Rating Scale [MADRS] and a psychiatric interview. DSM-IV-TR diagnoses were established by an expert panel blinded to the self-reported rating scale data. Receiver operating characteristic curves were used to estimate the area under the curve (AUC) of each scale.

Results: All scales performed better than chance (AUC 0.75-0.85). Sensitivity ranged from 0.66 to 0.85 and specificity ranged from 0.60 to 0.88. The UPDRS Depression item had a smaller AUC than the BDI-II, HAM-D-17, IDS-C, and MADRS. The CESD-R also had a smaller AUC than the MADRS. The remaining AUCs were statistically similar.

Conclusions: The GDS-30 may be the most efficient depression screening scale to use in PD because of its brevity, favorable psychometric properties, and lack of copyright protection. However, all scales studied, except for the UPDRS Depression, are valid screening tools when PD-specific cutoff scores are used.

Figure 1. Flow of participants through the Methods of Optimal Depression Detection in Parkinson's Disease (MOOD-PD) study

BDI = Beck Depression Inventory; CESD-R = Center for Epidemiologic Studies Depression Rating Scale–Revised; GDS-30 = 30-item Geriatric Depression Scale; IDS-SR = Inventory of Depressive Symptoms–Patient; MMSE = Mini-Mental State Examination; PD = Parkinson disease; PHQ-9 = Patient Health Questionnaire-9.

Figure 2. Mean depressive symptom rating scale scores by depressive disorder subgroup

Major depression >No active depression (all scales: p < 0 · 001). Nonmajor depression >No active depression (17-item Hamilton Depression Rating Scale [HAM-D-17], Inventory of Depressive Symptoms–Clinician [IDS-C]: p < 0 · 001; Beck Depression Inventory-II [BDI-II], Inventory of Depressive Symptoms–Patient [IDS-SR]: p < 0 · 002; Montgomery-Åsberg Depression Rating Scale [MADRS]: p < 0 · 005; 30-item Geriatric Depression Scale [GDS-30]: p > 0 · 011; Center for Epidemiologic Studies Depression Rating Scale–Revised [CESD-R]: p > 0 · 128; Patient Health Questionnaire-9 [PHQ-9]: p > 0 · 291; Unified Parkinson's Disease Rating Scale Depression [UPDRS-Dep]: p > 0 · 382). Major depression > Nonmajor depression (MADRS, PHQ-9, UPDRS-Dep: p < 0 · 001; HAM-D-17, IDS-C: p < 0 · 002; GDS-30: p < 0 · 006; CESD-R: p < 0 · 009; BDI-II: p < 0 · 046; IDS-SR: p < 0 · 060). CI = confidence interval.