A comparison of nine scales to detect depression in Parkinson disease: Which scale to use? (original) (raw)

Objective: The Methods of Optimal Depression Detection in Parkinson's Disease (MOOD-PD) study compared the psychometric properties of 9 depression scales to provide guidance on scale selection in Parkinson disease (PD). Methods: Patients with PD (n ϭ 229) from community-based neurology practices completed 6 self-report scales (Beck Depression Inventory [BDI]-II, Center for Epidemiologic Studies Depression Rating Scale-Revised [CESD-R], 30-item Geriatric Depression Scale [GDS-30], Inventory of Depressive Symptoms-Patient [IDS-SR], Patient Health Questionnaire-9 [PHQ-9], and Unified Parkinson's Disease Rating Scale [UPDRS]-Part I) and were administered 3 clinician-rated scales (17-item Hamilton Depression Rating Scale [HAM-D-17], Inventory of Depressive Symptoms-Clinician [IDS-C], and Montgomery-Åsberg Depression Rating Scale [MADRS] and a psychiatric interview. DSM-IV-TR diagnoses were established by an expert panel blinded to the self-reported rating scale data. Receiver operating characteristic curves were used to estimate the area under the curve (AUC) of each scale. Results: All scales performed better than chance (AUC 0.75-0.85). Sensitivity ranged from 0.66 to 0.85 and specificity ranged from 0.60 to 0.88. The UPDRS Depression item had a smaller AUC than the BDI-II, HAM-D-17, IDS-C, and MADRS. The CESD-R also had a smaller AUC than the MADRS. The remaining AUCs were statistically similar. Conclusions: The GDS-30 may be the most efficient depression screening scale to use in PD because of its brevity, favorable psychometric properties, and lack of copyright protection. However, all scales studied, except for the UPDRS Depression, are valid screening tools when PD-specific cutoff scores are used. Neurology ® 2012;78:998-1006 GLOSSARY AUC ϭ area under the curve; BDI ϭ Beck Depression Inventory; CESD-R ϭ Center for Epidemiologic Studies Depression Rating Scale-Revised; GDS ϭ Geriatric Depression Scale; H&Y ϭ Hoehn and Yahr; HAM-D-17 ϭ 17-item Hamilton Depression Rating Scale; IDS-C ϭ Inventory of Depressive Symptoms-Clinician; IDS-SR ϭ Inventory of Depressive Symptoms-Patient; MADRS ϭ Montgomery-Åsberg Depression Rating Scale; MMSE ϭ Mini-Mental State Examination; MOOD-PD ϭ Methods of Optimal Depression Detection in Parkinson's Disease; NPV ϭ negative predictive value; PD ϭ Parkinson disease; PHQ-9 ϭ Patient Health Questionnaire-9; PPV ϭ positive predictive value; ROC ϭ receiver operating characteristic; SCID ϭ Structured Clinical Interview for DSM Disorders; UPDRS ϭ Unified Parkinson's Disease Rating Scale. Depressive syndromes affect an estimated 40% of patients with Parkinson disease (PD). 1 However, depressive syndromes in PD are often unrecognized or inadequately treated. 2 Routine use of depressive symptom rating scales may improve detection of depression in PD. In 2009, the US Preventive Services Task Force recommended use of depression scales in primary care but did not recommend a specific scale. 3 Similarly, no one scale is recommended in PD. 4 Depression screening tools should be both sensitive and specific to the broad differential diagnosis of depressed mood in PD. 5,6 Although not a substitute for a diagnostic evaluation, scales