title: A comparison of multiple patient reported outcome measures in identifying major depressive disorder in people with multiple sclerosis.
abstract: BACKGROUND
  Depression is one of the most prominent and debilitating symptoms in individuals with multiple sclerosis (MS), yet there is currently no consensus on the best instruments for depression screening in MS. More head to head comparisons of available screening instruments are needed to advise MS researchers and clinicians.
  
  
  METHODS
  A cross-sectional comparison of the effectiveness of screening for MDD using multiple patient reported outcome (PRO) screeners against a modified SCID telephone interview was completed in 164 individuals with MS. Stratum goals were set for depression levels to ensure participation by people with borderline and higher levels of depression. Criterion standard was a modified SCID MDD module. PRO measures included the PHQ-9, BDI-FS, PROMIS depression, Neuro-QOL depression, M-PHQ-2, PHQ-2, and CESD.
  
  
  RESULTS
  48 (29%) individuals met the modified SCID criteria for MDD. The sensitivity of the PRO measures ranged from 60% to 100% while specificity ranged from 46% to 86%. The ROC area for the PRO measures ranged from 0.79 to 0.83. Revised (higher) cutoff scores were suggested by the ROC analyses for most self-reported screeners.
  
  
  CONCLUSIONS
  Enrollment was stopped early because of difficulties with recruitment. Several SCID recording could not be reviewed and diagnosis confirmed.
  
  
  CONCLUSIONS
  CESD-10 and PHQ9 had the best diagnostic performance using optimal cutoffs, but no one PRO measure stood out as significantly better than any other. Even when revised cutoff scores were used, none of the self-reported screeners identified people with MDD with adequate accuracy. More accurate self-reported screeners would facilitate diagnosing of MDD for both research and clinical purposes.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA. Electronic address: dagmara@uw.edu.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Amtmann
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Alyssa M
authors.initials: AM
authors.lastname: Bamer
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Kurt L
authors.initials: KL
authors.lastname: Johnson
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Ehde
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Meghan L
authors.initials: ML
authors.lastname: Beier
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Elzea
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Bombardier
mesh_terms: D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000209:etiology* / Q000523:psychology / Q000628:therapy*; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Beck depression; CESD; Depression; Diagnostic accuracy; Neuro-QOL; PHQ; PROMIS; SCID