title: 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.
abstract: OBJECTIVE
  Major 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.
  
  
  METHODS
  A 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.").
  
  
  RESULTS
  Overall, 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.
  
  
  CONCLUSIONS
  Among 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.
authors.affiliation: The Ontario HIV Treatment Network, Toronto, Ontario, Canada.|The Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Stephanie K Y
authors.initials: SK
authors.lastname: Choi
authors.affiliation: Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Boyle
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ann N
authors.initials: AN
authors.lastname: Burchell
authors.affiliation: The Ontario HIV Treatment Network, Toronto, Ontario, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Gardner
authors.affiliation: University Health Network, Toronto, Ontario, Canada.|Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Evan
authors.initials: E
authors.lastname: Collins
authors.affiliation: Division of Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.|Department of Economics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Grootendorst
authors.affiliation: The Ontario HIV Treatment Network, Toronto, Ontario, Canada.|Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.|St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Sean B
authors.initials: SB
authors.lastname: Rourke
mesh_terms: D000328:Adult; D019540:Area Under Curve; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003625:Data Collection; D003865:Major Depressive Disorder / Q000175:diagnosis*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000523:psychology*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015233:Models, Statistical; D009864:Ontario / Q000453:epidemiology; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics / Q000379:methods; D012372:ROC Curve; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires