title: Clinical utility of the Montgomery-Åsberg Depression Rating Scale for the detection of depression among bariatric surgery candidates.
abstract: BACKGROUND
  Clinical assessment of depression is an important part of pre-surgical assessment among individuals with morbid obesity. However, there is no agreed-upon instrument to identify mood psychopathology in this population. We examined the reliability and criterion validity of the clinician-administered Montgomery-Åsberg Depression Rating Scale (MADRS) and the utility of a short version for bariatric surgery candidates.
  
  
  METHODS
  The sample was 374 patients with obesity, consecutively recruited from the waiting list of a bariatric surgery clinic of University Hospital, Brazil: women 80%, mean BMI 47 kg/m(2), mean age 43.0 years. The 10-item MADRS was analyzed against the SCID-I. Items that showed small relevance to sample's characteristics and contribution to data variability were removed to develop the short 5-item version of scale. We calculated the sensitivity and specificity of cutoff points of both versions MADRS, and values were plotted as a receiver operating characteristic curve.
  
  
  RESULTS
  For the 10-item MADRS, the Cronbach's alpha coefficient was 0.93. When compared against SCID-I, the best cut-off threshold was 13/14, yielding sensitivity of 0.81 and specificity 0.85. Following items were removed: reduced appetite, reduced sleep, concentration difficulties, suicide thought and lassitude. The 5-item version showed an alpha coefficient of 0.94 and a best cut-off threshold of 10/11, yielding sensitivity of 0.81 and specificity 0.87. Similar overall ability to discriminate depression of almost 90% was found for both 10-item and 5-item MADRS.
  
  
  CONCLUSIONS
  The MADRS is a reliable and valid instrument to assess depressive symptoms among treatment-seeking bariatric patients. Systematic application of the abbreviated version of the MADRS can be recommended for enhancing the clinical detection of depression during perioperative period.
authors.affiliation: Department and Institute of Psychiatry (LIM-23), University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Leorides Severo
authors.initials: LS
authors.lastname: Duarte-Guerra
authors.affiliation: Department and Institute of Psychiatry (LIM-23), University of São Paulo Medical School, São Paulo, Brazil.|Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.
authors.forename: Clarice
authors.initials: C
authors.lastname: Gorenstein
authors.affiliation: Department and Institute of Psychiatry (LIM-23), University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Paula Francinelle
authors.initials: PF
authors.lastname: Paiva-Medeiros
authors.affiliation: Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Marco Aurélio
authors.initials: MA
authors.lastname: Santo
authors.affiliation: Department and Institute of Psychiatry (LIM-23), University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Francisco
authors.initials: F
authors.lastname: Lotufo Neto
authors.affiliation: Department and Institute of Psychiatry (LIM-23), University of São Paulo Medical School, São Paulo, Brazil. gnap_inbox@hotmail.com.|Instituto & Departamento de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos. no. 785, 05403-010, São Paulo, Brazil. gnap_inbox@hotmail.com.
authors.forename: Yuan-Pang
authors.initials: YP
authors.lastname: Wang
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D001938:Brazil; D003863:Depression / Q000175:diagnosis* / Q000209:etiology; D003866:Depressive Disorder / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Bariatric surgery; Depression; Obesity; Psychopathology