title: Risk of bias from inclusion of patients who already have diagnosis of or are undergoing treatment for depression in diagnostic accuracy studies of screening tools for depression: systematic review.
abstract: OBJECTIVE
  To investigate the proportion of original studies included in systematic reviews and meta-analyses on the diagnostic accuracy of screening tools for depression that appropriately exclude patients who already have a diagnosis of or are receiving treatment for depression and to determine whether these systematic reviews and meta-analyses evaluate possible bias from the inclusion of such patients.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Medline, PsycINFO, CINAHL, Embase, ISI, SCOPUS, and Cochrane databases were searched from 1 January 2005 to 29 October 2009.
  
  
  METHODS
  Systematic reviews and meta-analyses in any language that reported on the diagnostic accuracy of screening tools for depression.
  
  
  RESULTS
  Only eight of 197 (4%) unique publications from 17 systematic reviews and meta-analyses specifically excluded patients who already had a diagnosis of or were receiving treatment for depression. No systematic reviews or meta-analyses commented on possible bias from the inclusion of such patients, even though 10 reviews used quality assessment tools with items to rate risk of bias from composition of the sample of patients.
  
  
  CONCLUSIONS
  Studies of the accuracy of screening tools for depression rarely exclude patients who already have a diagnosis of or are receiving treatment for depression, a potential bias that is not evaluated in systematic reviews and meta-analyses. This could result in inflated estimates of accuracy on which clinical practice and preventive care guidelines are often based, a problem that takes on greater importance as the rate of diagnosed and treated depression in the population increases.
authors.affiliation: Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. brett.thombs@mcgill.ca
authors.forename: Brett D
authors.initials: BD
authors.lastname: Thombs
authors.forename: Erin
authors.initials: E
authors.lastname: Arthurs
authors.forename: Ghassan
authors.initials: G
authors.lastname: El-Baalbaki
authors.forename: Anna
authors.initials: A
authors.lastname: Meijer
authors.forename: Roy C
authors.initials: RC
authors.lastname: Ziegelstein
authors.forename: Russell J
authors.initials: RJ
authors.lastname: Steele
mesh_terms: D015982:Bias; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008403:Mass Screening / Q000592:standards*; D015201:Meta-Analysis as Topic; D012196:Review Literature as Topic