title: Detecting depression in Parkinson disease: A systematic review and meta-analysis.
abstract: BACKGROUND
  Failure to detect depression in patients with Parkinson disease (PD) can lead to worsened outcomes for patients and caregivers. Accurate identification of depression would enable practitioners to provide comprehensive care for their patients with PD.
  
  
  METHODS
  Our objective was to examine the diagnostic accuracy of tools for detecting depression in adult outpatients with PD. We searched MEDLINE, PsycINFO, and EMBASE (inception to December 1, 2015), gray literature, and bibliographies of included studies. The pooled prevalence of depression across studies and diagnostic accuracy estimates were calculated using random-effects models. Diagnostic accuracy estimates were calculated across the best-reported cutoffs from each study and across specific cutoffs, when feasible.
  
  
  RESULTS
  Out of 8,184 citations, 21 studies were included, evaluating 24 tools, with 4 amenable to meta-analysis. The pooled prevalence of major depression was 22.9% (95% confidence interval [CI] 18.1-27.7). The 15-item Geriatric Depression Scale (GDS-15) had a pooled sensitivity of 0.81 (95% CI 0.64-0.91) and specificity of 0.91 (95% CI 0.87-0.94). The most sensitive cutoff for the GDS-15 was 5 at 0.91 (95% CI 0.83-1.00). The Beck Depression Inventory I/Ia had a pooled sensitivity of 0.79 (95% CI 0.61-0.90) and specificity of 0.85 (95% CI 0.79-0.90). The Montgomery-Åsberg Depression Rating Scale yielded a pooled sensitivity of 0.77 (95% CI 0.69-0.83) and specificity of 0.92 (95% CI 0.79-0.97). The Unified Parkinson's Disease Rating Scale had a pooled sensitivity of 0.72 (95% CI 0.64-0.79) and specificity of 0.80 (95% CI 0.70-0.87). All estimates had heterogeneity.
  
  
  CONCLUSIONS
  There are several valid tools for detecting depression in patients with PD. Practitioners should choose one that fits their clinical practice.
authors.affiliation: From the Departments of Community Health Sciences (Z.G., K.J.M., D.J.R., N.J., T.P., J.H.-L.) and Clinical Neurosciences (N.J., T.P.), University of Calgary; Research Priorities and Implementation (K.J.M.), Alberta Health Services, Edmonton; Departments of Critical Care Medicine (D.J.R.) and Surgery (D.J.R.), Hotchkiss Brain Institute and O'Brien Institute for Public Health (N.J., T.P., J.H.-L.), and Departments of Psychiatry and Pediatrics (T.P.) and Medicine (Z.G., J.H.-L.), University of Calgary and Alberta Health Services, Canada. zahra.goodarzi@albertahealthservices.ca.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Goodarzi
authors.affiliation: From the Departments of Community Health Sciences (Z.G., K.J.M., D.J.R., N.J., T.P., J.H.-L.) and Clinical Neurosciences (N.J., T.P.), University of Calgary; Research Priorities and Implementation (K.J.M.), Alberta Health Services, Edmonton; Departments of Critical Care Medicine (D.J.R.) and Surgery (D.J.R.), Hotchkiss Brain Institute and O'Brien Institute for Public Health (N.J., T.P., J.H.-L.), and Departments of Psychiatry and Pediatrics (T.P.) and Medicine (Z.G., J.H.-L.), University of Calgary and Alberta Health Services, Canada.
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Mrklas
authors.affiliation: From the Departments of Community Health Sciences (Z.G., K.J.M., D.J.R., N.J., T.P., J.H.-L.) and Clinical Neurosciences (N.J., T.P.), University of Calgary; Research Priorities and Implementation (K.J.M.), Alberta Health Services, Edmonton; Departments of Critical Care Medicine (D.J.R.) and Surgery (D.J.R.), Hotchkiss Brain Institute and O'Brien Institute for Public Health (N.J., T.P., J.H.-L.), and Departments of Psychiatry and Pediatrics (T.P.) and Medicine (Z.G., J.H.-L.), University of Calgary and Alberta Health Services, Canada.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Roberts
authors.affiliation: From the Departments of Community Health Sciences (Z.G., K.J.M., D.J.R., N.J., T.P., J.H.-L.) and Clinical Neurosciences (N.J., T.P.), University of Calgary; Research Priorities and Implementation (K.J.M.), Alberta Health Services, Edmonton; Departments of Critical Care Medicine (D.J.R.) and Surgery (D.J.R.), Hotchkiss Brain Institute and O'Brien Institute for Public Health (N.J., T.P., J.H.-L.), and Departments of Psychiatry and Pediatrics (T.P.) and Medicine (Z.G., J.H.-L.), University of Calgary and Alberta Health Services, Canada.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Jette
authors.affiliation: From the Departments of Community Health Sciences (Z.G., K.J.M., D.J.R., N.J., T.P., J.H.-L.) and Clinical Neurosciences (N.J., T.P.), University of Calgary; Research Priorities and Implementation (K.J.M.), Alberta Health Services, Edmonton; Departments of Critical Care Medicine (D.J.R.) and Surgery (D.J.R.), Hotchkiss Brain Institute and O'Brien Institute for Public Health (N.J., T.P., J.H.-L.), and Departments of Psychiatry and Pediatrics (T.P.) and Medicine (Z.G., J.H.-L.), University of Calgary and Alberta Health Services, Canada.
authors.forename: Tamara
authors.initials: T
authors.lastname: Pringsheim
authors.affiliation: From the Departments of Community Health Sciences (Z.G., K.J.M., D.J.R., N.J., T.P., J.H.-L.) and Clinical Neurosciences (N.J., T.P.), University of Calgary; Research Priorities and Implementation (K.J.M.), Alberta Health Services, Edmonton; Departments of Critical Care Medicine (D.J.R.) and Surgery (D.J.R.), Hotchkiss Brain Institute and O'Brien Institute for Public Health (N.J., T.P., J.H.-L.), and Departments of Psychiatry and Pediatrics (T.P.) and Medicine (Z.G., J.H.-L.), University of Calgary and Alberta Health Services, Canada.
authors.forename: Jayna
authors.initials: J
authors.lastname: Holroyd-Leduc
mesh_terms: D003863:Depression / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology*; D017408:Guidelines as Topic; D006801:Humans; D010300:Parkinson Disease / Q000150:complications / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index