Validation of Six Short and Ultra-short Screening Instruments for Depression for People Living with HIV in Ontario: Results from the Ontario HIV Treatment Network Cohort Study.

Stephanie K Y Choi,Ann N Burchell,Evan Collins,Paul Grootendorst,Sandra Gardner,Eleanor Boyle,Sean B Rourke,Jialin Charles Zheng

doi:10.1371/journal.pone.0142706

Abstract

ObjectiveMajor depression affects up to half of people living with HIV. However, among HIV-positive patients, depression goes unrecognized 60–70% of the time in non-psychiatric settings. We sought to evaluate three screening instruments and their short forms to facilitate the recognition of current depression in HIV-positive patients attending HIV specialty care clinics in Ontario.MethodsA multi-centre validation study was conducted in Ontario to examine the validity and accuracy of three instruments (the Center for Epidemiologic Depression Scale [CESD20], the Kessler Psychological Distress Scale [K10], and the Patient Health Questionnaire depression scale [PHQ9]) and their short forms (CESD10, K6, and PHQ2) in diagnosing current major depression among 190 HIV-positive patients in Ontario. Results from the three instruments and their short forms were compared to results from the gold standard measured by Mini International Neuropsychiatric Interview (the “M.I.N.I.”).ResultsOverall, the three instruments identified depression with excellent accuracy and validity (area under the curve [AUC]>0.9) and good reliability (Kappa statistics: 0.71–0.79; Cronbach’s alpha: 0.87–0.93). We did not find that the AUCs differed in instrument pairs (p-value>0.09), or between the instruments and their short forms (p-value>0.3). Except for the PHQ2, the instruments showed good-to-excellent sensitivity (0.86–1.0) and specificity (0.81–0.87), excellent negative predictive value (>0.90), and moderate positive predictive value (0.49–0.58) at their optimal cut-points.ConclusionAmong people in HIV care in Ontario, Canada, the three instruments and their short forms performed equally well and accurately. When further in-depth assessments become available, shorter instruments might find greater clinical acceptance. This could lead to clinical benefits in fast-paced speciality HIV care settings and better management of depression in HIV-positive patients.

Highlights

Depression affects up to half of people living with HIV [1,2,3,4]
Results from the three instruments and their short forms were compared to results from the gold standard measured by Mini International Neuropsychiatric Interview
Our consent procedure was approved by all the ethics boards involved and written informed consent was obtained from each participant

Summary

Introduction

Depression goes unrecognized in about 60–70% of HIV-positive patients in non-psychiatric healthcare settings [5,6,7,8]. When depression is left untreated in HIV-positive patients, it can reduce immune activity [9,10,11,12] increase the risk of co-morbidities and mortality [13,14], and reduce quality of life [15]. Because of the substantive negative impacts of depression on clinical outcomes normally found among HIV-positive patients, recent guidelines from Canada, U.K. and the U.S recommend that screening should be undertaken if follow-up in-depth assessments are available [17,18,19]. Despite ongoing debates about the effectiveness of these instruments, a recent meta-analysis of 113 studies has shown that most instruments demonstrate adequate performance when used in the initial assessment of depression among patients with physical illness [20]

Methods

Results

Conclusion