Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Aug 16;24(9):1867-1875.
doi: 10.1093/ibd/izy068.

The Validity and Reliability of Screening Measures for Depression and Anxiety Disorders in Inflammatory Bowel Disease

Charles N Bernstein  1 , Lixia Zhang  2 , Lisa M Lix  2 , Lesley A Graff  3 , John R Walker  3 , John D Fisk  4 , Scott B Patten  5 , Carol A Hitchon  1 , James M Bolton  6 , Jitender Sareen  6 , Renée El-Gabalawy  3   7 , James Marriott  1 , Ruth Ann Marrie  1   2 ; CIHR Team in Defining the Burden and Managing the Effects of Immune-mediated Inflammatory Disease
Affiliations

The Validity and Reliability of Screening Measures for Depression and Anxiety Disorders in Inflammatory Bowel Disease

Charles N Bernstein et al. Inflamm Bowel Dis. .

Abstract

Background: We evaluated the validity and reliability of multiple symptom scales for depression and anxiety for persons with inflammatory bowel disease (IBD).

Methods: IBD participants in a cohort study completed a Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) and completed the Patient Health Questionnaire (PHQ-9), Hospital Anxiety and Depression Scale (HADS), Kessler-6 Distress Scale, PROMIS Emotional Distress Depression Short-Form 8a (PROMIS Depression) and Anxiety Short-Form 8a (PROMIS Anxiety), Generalized Anxiety Disorder 7-item Scale, and Overall Anxiety and Severity Impairment Scale. We computed sensitivity, specificity, and positive and negative predictive values for the screening measures with the SCID diagnoses as the reference standard, conducted receiver operating curve (ROC) analysis, and assessed internal consistency and test-retest reliability.

Results: Of 242 participants, the SCID classified 8.7% as having major depression and 17.8% as having anxiety disorders. Among the depression scales, the PHQ-9 had the highest sensitivity (95%). Specificity was generally higher than sensitivity and was highest for the HADS-D (cut-point of 11; 97%). The area under the ROC curve (AUC) did not differ significantly among depression scales. Among the anxiety scales, sensitivity was highest for the PROMIS (79%). Specificity ranged from 82% to 88% for all tools except the HADS-A (cut-point of 8; 65%). The AUC did not differ between depression and anxiety tools.

Conclusions: Overall, the symptom scales for depression and anxiety were similar in their psychometric properties. The anxiety scales did not perform as well as the depression scales. Alternate cut-points may be more relevant when these scales are used in an IBD sample.

Keywords: anxiety; depression; inflammatory bowel disease; psychometric properties.

PubMed Disclaimer

Figures

FIGURE 1.
FIGURE 1.
Receiver operating characteristic curves for depression screening measures as compared with the SCID depression.
FIGURE 2.
FIGURE 2.
Receiver operating characteristic curves for anxiety screening measures as compared with the SCID anxiety.
See this image and copyright information in PMC

References

    1. Singh S, Blanchard A, Walker JR et al. Common symptoms and stressors among individuals with inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2011;9:769–75. - PubMed
    1. Walker JR, Ediger JP, Graff LA et al. The Manitoba IBD Cohort Study: a population-based study of the prevalence of lifetime and 12-month anxiety and mood disorders. Am J Gastroenterol. 2008;103:1989–97. - PubMed
    1. Marrie RA, Walld R, Bolton JM et al. ; CIHR Team in Defining the Burden and Managing the Effects of Psychiatric Comorbidity in Chronic Immunoinflammatory Disease Increased incidence of psychiatric disorders in immune-mediated inflammatory disease. J Psychosom Res. 2017;101:17–23. - PubMed
    1. Bernstein CN, Hitchon CA, Walld R et al. Increased burden of psychiatric disorders in inflammatory bowel disease. Gastroenterology. 2018; 152: S973. - PMC - PubMed
    1. Ananthakrishnan AN, Gainer VS, Cai T et al. Similar risk of depression and anxiety following surgery or hospitalization for Crohn’s disease and ulcerative colitis. Am J Gastroenterol. 2013;108:594–601. - PMC - PubMed