title: Validity of four screening scales for major depression in MS.
abstract: BACKGROUND
  There is a role for brief assessment instruments in detection and management of major depression in MS. However, candidate scales have rarely been validated against a validated diagnostic interview. In this study, we evaluated the performance of several candidate scales: Patient Health Questionnaire (PHQ)-9, PHQ-2, Center for Epidemiologic Studies Depression rating scale (CES-D), and Hospital Anxiety and Depression Scale (HADS-D) in relation to the Structured Clinical Interview for DSM-IV (SCID).
  
  
  METHODS
  The sample was an unselected series of 152 patients attending a multiple sclerosis (MS) clinic. Participants completed the scales during a clinic visit or returned them by mail. The SCID was administered by telephone within two weeks. The diagnosis of major depressive episode, according to the SCID, was used as a reference standard. Receiver-operator curves (ROC) were fitted and indices of measurement accuracy were calculated.
  
  
  RESULTS
  All of the scales performed well, each having an area under the ROC > 90%. For example, the PHQ-9 had 95% sensitivity and 88.3% specificity when scored with a cut-point of 11. This cut-point achieved a 56% positive predictive value for major depression.
  
  
  CONCLUSIONS
  While all of the scales performed well in terms of their sensitivity and specificity, the availability of the PHQ-9 in the public domain and its brevity may enhance the feasibility of its use.
authors.affiliation: Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada/Mathison Centre for Research & Education in Mental Health, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada patten@ucalgary.ca.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Patten
authors.affiliation: Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada/Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jodie M
authors.initials: JM
authors.lastname: Burton
authors.affiliation: Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Kirsten M
authors.initials: KM
authors.lastname: Fiest
authors.affiliation: Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada/Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Samuel
authors.initials: S
authors.lastname: Wiebe
authors.affiliation: Mathison Centre for Research & Education in Mental Health, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada/Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Andrew G M
authors.initials: AG
authors.lastname: Bulloch
authors.affiliation: Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada/Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Marcus
authors.initials: M
authors.lastname: Koch
authors.affiliation: Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Dobson
authors.affiliation: Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada/Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Luanne M
authors.initials: LM
authors.lastname: Metz
authors.affiliation: School of Pharmacy, University of Waterloo, Ontario, Canada.
authors.forename: Colleen J
authors.initials: CJ
authors.lastname: Maxwell
authors.affiliation: Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada/Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Jetté
mesh_terms: D017668:Age of Onset; D003865:Major Depressive Disorder / Q000209:etiology* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000188:drug therapy / Q000523:psychology*; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D012372:ROC Curve; D012008:Recurrence; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Outcome measurement; multiple sclerosis; quality of life; symptomatic treatment