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Performance of depression rating scales in patients with chronic kidney disease: an item response theory-based analysis.

ABSTRACT: Because there is overlap between somatic symptoms of depression and symptoms of chronic kidney disease (CKD), it is unclear if self-reported depression rating scales can be used accurately in predialysis CKD patients, especially if CKD and other comorbidities are symptomatic. We assessed the performance of two depression scales - the Beck Depression Inventory (BDI) and the Quick Inventory of Depression Symptomatology (QIDS-SR16) - by CKD stage, diagnosis of diabetes and total medical comorbidity burden - using item response theory (IRT) in a sample of 272 predialysis CKD patients.We performed IRT by low versus high CKD stage, diabetes versus no diabetes and high (>3 diagnoses) versus low medical comorbidity burden.IRT models of each rating scale were affected in a limited way by CKD stage, diabetes and medical comorbidity burden. Sleep disturbances on the QIDS-SR16 were more discriminatory for depression in diabetics and those with high comorbidity burden. Pessimism and guilt from the BDI compared to QIDS-SR16 were more discriminatory of depression in the high CKD and high comorbidity groups, respectively.Overall item differences were modest, and chronic disease severity by CKD stage, diabetes mellitus or other medical comorbidities did not appreciably contribute to differences in scale performance.

SUBMITTER: Toups M

PROVIDER: S-EPMC5724363 | biostudies-other | 2016 Sep-Oct

REPOSITORIES: biostudies-other

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Performance of depression rating scales in patients with chronic kidney disease: an item response theory-based analysis.

Toups Marisa M Carmody Thomas T Trivedi Madhukar H MH Rush A John AJ Hedayati S Susan SS

General hospital psychiatry 20160725

<h4>Objective</h4>Because there is overlap between somatic symptoms of depression and symptoms of chronic kidney disease (CKD), it is unclear if self-reported depression rating scales can be used accurately in predialysis CKD patients, especially if CKD and other comorbidities are symptomatic. We assessed the performance of two depression scales - the Beck Depression Inventory (BDI) and the Quick Inventory of Depression Symptomatology (QIDS-SR16) - by CKD stage, diagnosis of diabetes and total m ...[more]

PMID: 27638974

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Project description:ObjectiveTo develop clinically meaningful improvement thresholds in both the 17-item and the 6-item Hamilton Rating Scale for Depression (HRSD) total scores in depressed outpatients.MethodsThe post-hoc analysis included all adult outpatients with non-psychotic major depressive disorder in the STAR*D trial who entered and exited the first treatment step (up to 14 weeks of citalopram) with a complete set of study measures at baseline and exit and at least one post-baseline measure. Within-patient change and linear regression anchor-based analyses were conducted to define meaningful and substantial changes in the HRSD17 and HRSD6 using three patient-reported outcomes [Work and Social Adjustment Scale (WSAS), Quality of Life Enjoyment and Satisfaction-Short Form (Q-LES-Q-SF); Mini-Q-LES-Q] obtained at baseline and exit from the first treatment step in STAR*D.ResultsLinear regression analyses identified a meaningful change threshold for the HRSD17 as 3.9 [3.7-4.1] [lower, upper 95% CI] and a substantial change as 7.8 [7.4-8.3] with the WSAS. Analogous thresholds based on the Q-LES-Q-SF were 5.8 [5.5-6.1] and 11.6 [11.0-12.2], respectively, and 4.9 [4.7-5.2] and 9.9 [9.3-10.4] for the Mini-QLES-Q, respectively. For the HRSD6, linear regression analyses with the WSAS identified a meaningful change as 2.2 [2.1-2.4], while a substantial change was 4.5 [4.2-4.7]. Analogous figures based on the Q-LES-Q-SF were 3.2 [3.0-3.4] and 6.4 [6.1-6.8]. Similarly, based on the Mini-QLESQ, results were 2.8 [2.6-2.9] and 5.6 [5.3-5.9]. For both the HRSD17 and the HRSD6, within-patient analyses produced less precise estimates of the same change thresholds with substantial overlap between groups. Based on the WSAS, a clinically meaningful change in the HRSD17 total score was 9.6 (SD = 6.5), while a substantial change was 15.0 (SD = 6.7). Analogous change thresholds based on the Q-LESQ-SF were 12.9 (SD = 6.2) and 16.8 (SD = 6.4), respectively. For the Mini-Q-LES-Q, thresholds were 10.9 (SD = 6.5) and 16.1 (SD = 6.2).ConclusionA 4-6 point change in the HRSD17 is clinically meaningful; a 7-12 point change is clinically substantial. For the HRSD6, analogous estimates were 2-3 and 4-7 point changes, respectively.

Project description:BackgroundAlthough nontremor and tremor Part 3 Movement Disorder Society-Unified Parkinson's Disease Rating Scale items measure different impairment domains, their distinct progression and drug responsivity remain unstudied longitudinally. The total score may obscure important time-based and treatment-based changes occurring in the individual domains.ObjectiveUsing the unique advantages of item response theory (IRT), we developed novel longitudinal unidimensional and multidimensional models to investigate nontremor and tremor changes occurring in an interventional Parkinson's disease (PD) study.MethodWith unidimensional longitudinal IRT, we assessed the 33 Part 3 item data (22 nontremor and 10 tremor items) of 336 patients with early PD from the STEADY-PD III (Safety, Tolerability, and Efficacy Assessment of Isradipine for PD, placebo vs. isradipine) study. With multidimensional longitudinal IRT, we assessed the progression rates over time and treatment (in overall motor severity, nontremor, and tremor domains) using Markov Chain Monte Carlo implemented in Stan.ResultsRegardless of treatment, patients showed significant but different time-based deterioration rates for total motor, nontremor, and tremor scores. Isradipine was associated with additional significant deterioration over placebo in total score and nontremor scores, but not in tremor score. Further highlighting the 2 separate latent domains, nontremor and tremor severity changes were positively but weakly correlated (correlation coefficient, 0.108).ConclusionsLongitudinal IRT analysis is a novel statistical method highly applicable to PD clinical trials. It addresses limitations of traditional linear regression approaches and previous IRT investigations that either applied cross-sectional IRT models to longitudinal data or failed to estimate all parameters simultaneously. It is particularly useful because it can separate nontremor and tremor changes both over time and in response to treatment interventions.

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Performance of depression rating scales in patients with chronic kidney disease: an item response theory-based analysis.

Publications

Performance of depression rating scales in patients with chronic kidney disease: an item response theory-based analysis.

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