title: Screening for depression in epilepsy clinics. A comparison of conventional and visual-analog methods.
abstract: OBJECTIVE
  Depression is an important but underdiagnosed complication of epilepsy. This study compares potentially suitable screening tools head-to-head.
  
  
  METHODS
  We enrolled 266 attendees with a confirmed diagnosis of epilepsy at a specialized neurologic epilepsy service in London and compared verbal self-report and visual analog (VAS) screening methods for depression. These included two generic depression scales (Hospital Anxiety and Depression Scale [HADS], Beck Depression Inventory II [BDI-II]), one epilepsy specific scale (Neurological Disorders Depression Inventory for Epilepsy [NDDI-E]) and one new visual-analog scale (Emotional Thermometers [ET]). We used Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depression and International Classification of Diseases, Tenth Revision (ICD-10) criteria for depressive episode as the reference standard.
  
  
  RESULTS
  Against ICD-10-defined depression the most accurate scales by receiver operating characteristic (ROC) curve area were HADS Total (HADS-T, 0.924), BDI-II (0.898) and NDDI-E (0.897). New visual-analog methods had similar accuracy measured either in combination or individually. Although no test performed well in a case-finding role, several performed well as a rule-out initial step, owing to high negative predictive value and specificity. In this role, the optimal performing conventional tools were the HADS depression subsscale (HADS-D) and the NDDI-E and the optimal single VAS were the depression thermometer (DepT) and the distress thermometer (DT). Against DSM-IV- defined major depression, results were similar with optimal performance by the HADS-T, BDI-II, and NDDI-E, but here the anxiety thermometer (AnxT) as well as DepT and DT also offered good performance. Given that no test performed well in a case-finding role, we suggest that these tests are used as an initial first step to rule out patients who are unlikely to have depression.
  
  
  CONCLUSIONS
  We suggest that the six-item NDDI-E or seven-item HADS-D should be considered if a conventional scale is preferred and that the revised ET4 be considered if a visual-analog method is required. Follow-up examination and intervention, where indicated, are necessary in all those who screen positive on any measure as these are not intended as diagnostic tools.
authors: South West London & St George's Mental Health NHS Trust, Springfield University Hospital, London, United Kingdom. jeremy.rampling@swlstg-tr.nhs.uk
authors: Jeremy
authors: J
authors: Rampling
authors: Alex J
authors: AJ
authors: Mitchell
authors: Tim
authors: T
authors: Von Oertzen
authors: James
authors: J
authors: Docker
authors: Jemima
authors: J
authors: Jackson
authors: Hannah
authors: H
authors: Cock
authors: Niruj
authors: N
authors: Agrawal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003863:Depression / Q000175:diagnosis* / Q000209:etiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004827:Epilepsy / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D015203:Reproducibility of Results; D057566:Self Report; D055815:Young Adult