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. 2023 May 4;38(5):1318-1326.
doi: 10.1093/ndt/gfac262.

Two-step screening for depressive symptoms in patients treated with kidney replacement therapies: a cross-sectional analysis

Sumaya Dano  1 , Haoyue Helena Lan  1 , Sara Macanovic  1 , Susan Bartlett  2   3 , Doris Howell  4 , Madeline Li  4 , Janel Hanmer  5 , John Devin Peipert  6   7 , Marta Novak  8 , Istvan Mucsi  1
Affiliations

Two-step screening for depressive symptoms in patients treated with kidney replacement therapies: a cross-sectional analysis

Sumaya Dano et al. Nephrol Dial Transplant. .

Abstract

Background: Systematic screening for depressive symptoms may identify patients who may benefit from clinical assessment and psychosocial support. Here we assess a two-step screening using ultrabrief pre-screeners [Edmonton Symptom Assessment Survey-revised Depression item (ESASr-D) or Patient Health Questionnaire-2 (PHQ-2)] followed by the Patient-Reported Outcomes Measurement Information System Depression questionnaire (PROMIS-D) to identify depressive symptoms in patients on kidney replacement therapies.

Methods: We conducted a cross-sectional study of adults (kidney transplant recipients or treated with dialysis) in Toronto, ON, Canada. We simulated various two-step screening scenarios where only patients above a pre-screening cut-off score on the ESASr-D or PHQ-2 would move to step 2 (PROMIS-D). Screening performance was evaluated by sensitivity, specificity and positive and negative predictive values using the Patient Health Questionnaire-9 (PHQ-9) as the referent. The average number of items completed by patients in different scenarios was reported.

Results: Of 480 participants, 60% were male with a mean age of 55 years. Based on PHQ-9, 19% of patients had moderate or severe depressive symptoms. Pre-screening with a PHQ-2 score ≥1 combined with a PROMIS-D score of ≥53 provided the best two-step results (sensitivity 0.81, specificity 0.84, NPV 0.95). Two-step screening also reduces question burden.

Conclusions: A two-step screening using a PHQ-2 score ≥1 followed by a PROMIS-D score ≥53 has good sensitivity and specificity for identifying potentially significant depressive symptoms among patients on kidney replacement therapies. This approach has lower question burden. Screened-in patients will need further clinical assessment to establish a diagnosis.

Keywords: 2-step screening; PHQ-9; PROMIS; depressive symptoms; kidney failure.

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Conflict of interest statement

The authors declare no potential conflicts of interest.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
ROC curve of (A) ESASr-D, (B) PHQ-2 and (C) PROMIS-D T-scores against moderate to severe depression defined by PHQ-9 scores in the entire cohort.
See this image and copyright information in PMC

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