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Published in: BMC Psychiatry 1/2019

Open Access 01-12-2019 | Dysthymic Disorder | Research article

Psychometric evaluation of a screening question for persistent depressive disorder

Authors: Elisa Brinkmann, Sarah Glanert, Michael Hüppe, Ana Sofia Moncada Garay, Sophie Tschepe, Ulrich Schweiger, Jan Philipp Klein

Published in: BMC Psychiatry | Issue 1/2019

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Abstract

Background

About one in five patients with depression experiences a chronic course. Despite the great burden associated with this disease, there is no current screening instrument for Persistent Depressive Disorder (PDD). In the present study, we examine a short screening test, the persistent depression screener (PDS), that we developed for DSM-5 PDD. The PDS is comprised of one question that is administered following an initial self-assessment for depression.

Methods

Ninety patients from an inpatient clinic/day clinic specialized in treating depression completed the PDS. They were also assessed using a structured clinical interview covering the DSM-5 criteria for PDD. Retest reliability was examined after two weeks (n = 69, 77%).

Results

In this sample, the prevalence of PDD was 64%. Sensitivity of the PDS was 85% with a positive predictive value of 80%. Specificity was 63%. Positive and negative likelihood ratios were 2.3 and .24, respectively. Agreement between the PDS results and the outcome of the clinical interview was moderate (Cohen’s Kappa κ = .48 ([95%-CI .28, .68], p < .001, SE = 0.10)). Prevalence-adjusted bias-adjusted Kappa was PABAK = .53. Retest reliability of the PDS was moderate (Cohen’s Kappa κ = .52 ([95%-CI .3, .74], p < .001, SE = 0.11)).

Conclusions

The present study shows that the PDS - when applied following a self-rating depression scale - might be a valid and reliable way to detect PDD. However, the results of the PDS must be confirmed by a diagnostic interview.
Literature
1.
go back to reference Ferrari AJ, Charlson FJ, Norman RE, Patten SB, Freedman G, Murray CJL, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. Hay PJ, editor. PLoS Med. 2013;10:e1001547.CrossRef Ferrari AJ, Charlson FJ, Norman RE, Patten SB, Freedman G, Murray CJL, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. Hay PJ, editor. PLoS Med. 2013;10:e1001547.CrossRef
2.
go back to reference Lasserre AM, Marti-Soler H, Strippoli M-PF, Vaucher J, Glaus J, Vandeleur CL, et al. Clinical and course characteristics of depression and all-cause mortality: a prospective population-based study. J Affect Disord. 2016;189:17–24.CrossRef Lasserre AM, Marti-Soler H, Strippoli M-PF, Vaucher J, Glaus J, Vandeleur CL, et al. Clinical and course characteristics of depression and all-cause mortality: a prospective population-based study. J Affect Disord. 2016;189:17–24.CrossRef
3.
go back to reference Angst J, Gamma A, Rössler W, Ajdacic V, Klein DN. Long-term depression versus episodic major depression: results from the prospective Zurich study of a community sample. J Affect Disord. 2009;115:112–21.CrossRef Angst J, Gamma A, Rössler W, Ajdacic V, Klein DN. Long-term depression versus episodic major depression: results from the prospective Zurich study of a community sample. J Affect Disord. 2009;115:112–21.CrossRef
4.
go back to reference Hasin DS, Goodwin RD, Stinson FS, Grant BF. Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on alcoholism and related conditions. Arch Gen Psychiatry. 2005;62:1097–106.CrossRef Hasin DS, Goodwin RD, Stinson FS, Grant BF. Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on alcoholism and related conditions. Arch Gen Psychiatry. 2005;62:1097–106.CrossRef
5.
go back to reference Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). J Am Med Assoc. 2003;289:3095–105.CrossRef Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). J Am Med Assoc. 2003;289:3095–105.CrossRef
6.
go back to reference Eaton WW, Shao H, Nestadt G, Lee BH, Bienvenu OJ, Zandi P. Population-based study of first onset and chronicity in major depressive disorder. Arch Gen Psychiatry. 2008;65:513.CrossRef Eaton WW, Shao H, Nestadt G, Lee BH, Bienvenu OJ, Zandi P. Population-based study of first onset and chronicity in major depressive disorder. Arch Gen Psychiatry. 2008;65:513.CrossRef
7.
go back to reference Gilmer WS, Trivedi MH, Rush AJ, Wisniewski SR, Luther J, Howland RH, et al. Factors associated with chronic depressive episodes: a preliminary report from the STAR-D project. Acta Psychiatr Scand. 2005;112:425–33.CrossRef Gilmer WS, Trivedi MH, Rush AJ, Wisniewski SR, Luther J, Howland RH, et al. Factors associated with chronic depressive episodes: a preliminary report from the STAR-D project. Acta Psychiatr Scand. 2005;112:425–33.CrossRef
8.
go back to reference Kennedy N, Abbott R, Paykel ES. Remission and recurrence of depression in the maintenance era: long-term outcome in a Cambridge cohort. Psychol Med. 2003;33:827–38.CrossRef Kennedy N, Abbott R, Paykel ES. Remission and recurrence of depression in the maintenance era: long-term outcome in a Cambridge cohort. Psychol Med. 2003;33:827–38.CrossRef
9.
go back to reference Murphy JA, Byrne GJ. Prevalence and correlates of the proposed DSM-5 diagnosis of chronic depressive disorder. J Affect Disord. 2012;139:172–80.CrossRef Murphy JA, Byrne GJ. Prevalence and correlates of the proposed DSM-5 diagnosis of chronic depressive disorder. J Affect Disord. 2012;139:172–80.CrossRef
10.
go back to reference Satyanarayana S, Cox B, Sareen J. Prevalence and correlates of chronic depression in the Canadian community health survey: mental health and well-being. J Psychiatry. 2009;54:389–98. Satyanarayana S, Cox B, Sareen J. Prevalence and correlates of chronic depression in the Canadian community health survey: mental health and well-being. J Psychiatry. 2009;54:389–98.
11.
go back to reference Keller MB, Lavori PW, Mueller TI, Endicott J, Coryell W, Hirschfeld RMA, et al. Time to recovery, chronicity, and levels of psychopathology in major depression: a 5-year prospective follow-up of 431 subjects. Arch Gen Psychiatry. 1992;49:809–16.CrossRef Keller MB, Lavori PW, Mueller TI, Endicott J, Coryell W, Hirschfeld RMA, et al. Time to recovery, chronicity, and levels of psychopathology in major depression: a 5-year prospective follow-up of 431 subjects. Arch Gen Psychiatry. 1992;49:809–16.CrossRef
12.
go back to reference American Psychiatric Association. Diagnostical and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.CrossRef American Psychiatric Association. Diagnostical and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.CrossRef
13.
go back to reference Vandeleur CL, Fassassi S, Castelao E, Glaus J, Strippoli M-PF, Lasserre AM, et al. Prevalence and correlates of DSM-5 major depressive and related disorders in the community. Psychiatry Res. 2017;250:50–8.CrossRef Vandeleur CL, Fassassi S, Castelao E, Glaus J, Strippoli M-PF, Lasserre AM, et al. Prevalence and correlates of DSM-5 major depressive and related disorders in the community. Psychiatry Res. 2017;250:50–8.CrossRef
15.
go back to reference MacMillan HL, Patterson CJS, Wathen CN, The Canadian Task Force on Preventive health care. Screening for depression in primary care: recommendation statement from the Canadian Task Force on Preventive Health Care. Can Med Assoc J. 2005;172:33–5.CrossRef MacMillan HL, Patterson CJS, Wathen CN, The Canadian Task Force on Preventive health care. Screening for depression in primary care: recommendation statement from the Canadian Task Force on Preventive Health Care. Can Med Assoc J. 2005;172:33–5.CrossRef
16.
go back to reference Siu AL, Bibbins-Domingo K, Grossman DC, Baumann LC, Davidson KW, Ebell M, et al. Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016;315:380–7.CrossRef Siu AL, Bibbins-Domingo K, Grossman DC, Baumann LC, Davidson KW, Ebell M, et al. Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016;315:380–7.CrossRef
17.
go back to reference Rush AJ, Trivedi MH, Ibrahim HM, Carmody TJ, Arnow B, Klein DN, et al. The 16-item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry. 2003;54:573–83.CrossRef Rush AJ, Trivedi MH, Ibrahim HM, Carmody TJ, Arnow B, Klein DN, et al. The 16-item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry. 2003;54:573–83.CrossRef
18.
go back to reference Arroll B, Goodyear-Smith F, Crengle S, Gunn J, Kerse N, Fishman T, et al. Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med. 2010;8:348–53.CrossRef Arroll B, Goodyear-Smith F, Crengle S, Gunn J, Kerse N, Fishman T, et al. Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med. 2010;8:348–53.CrossRef
19.
go back to reference Löwe B, Kroenke K, Gräfe K. Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res. 2005;58:163–71.CrossRef Löwe B, Kroenke K, Gräfe K. Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res. 2005;58:163–71.CrossRef
20.
go back to reference Topp CW, Østergaard SD, Søndergaard S, Bech P. The WHO-5 well-being index: a systematic review of the literature. Psychother Psychosom. 2015;84:167–76.CrossRef Topp CW, Østergaard SD, Søndergaard S, Bech P. The WHO-5 well-being index: a systematic review of the literature. Psychother Psychosom. 2015;84:167–76.CrossRef
21.
go back to reference Jobst A, Brakemeier E-L, Buchheim A, Caspar F, Cuijpers P, Ebmeier KP, et al. European psychiatric association guidance on psychotherapy in chronic depression across Europe. Eur Psychiatry. 2016;33:18–36.CrossRef Jobst A, Brakemeier E-L, Buchheim A, Caspar F, Cuijpers P, Ebmeier KP, et al. European psychiatric association guidance on psychotherapy in chronic depression across Europe. Eur Psychiatry. 2016;33:18–36.CrossRef
22.
go back to reference Schramm E, Kriston L, Zobel I, Bailer J, Wambach K, Backenstrass M, et al. Effect of disorder-specific vs nonspecific psychotherapy for chronic depression: a randomized clinical trial. JAMA Psychiatry. 2017;74:233.CrossRef Schramm E, Kriston L, Zobel I, Bailer J, Wambach K, Backenstrass M, et al. Effect of disorder-specific vs nonspecific psychotherapy for chronic depression: a randomized clinical trial. JAMA Psychiatry. 2017;74:233.CrossRef
23.
go back to reference Wiersma JE, Van Schaik DJF, Hoogendorn AW, Dekker JJ, Van HL, Schoevers RA, et al. The effectiveness of the cognitive behavioral analysis system of psychotherapy for chronic depression: a randomized controlled trial. Psychother Psychosom. 2014;83:263–9.CrossRef Wiersma JE, Van Schaik DJF, Hoogendorn AW, Dekker JJ, Van HL, Schoevers RA, et al. The effectiveness of the cognitive behavioral analysis system of psychotherapy for chronic depression: a randomized controlled trial. Psychother Psychosom. 2014;83:263–9.CrossRef
24.
go back to reference Burnam MA, Wells KB, Leake B, Landsverk J. Development of a brief screening instrument for detecting depressive disorders. Med Care. 1988:775–89. Burnam MA, Wells KB, Leake B, Landsverk J. Development of a brief screening instrument for detecting depressive disorders. Med Care. 1988:775–89.
25.
go back to reference Geurtzen N, Keijsers GP, Karremans JC, Hutschemaekers GJ. Patients’ care dependency in mental health care: development of a self-report questionnaire and preliminary correlates. J Clin Psychol. 2018;74:1189–206. https://doi.org/10.1002/jclp.22574. Geurtzen N, Keijsers GP, Karremans JC, Hutschemaekers GJ. Patients’ care dependency in mental health care: development of a self-report questionnaire and preliminary correlates. J Clin Psychol. 2018;74:1189–206. https://​doi.​org/​10.​1002/​jclp.​22574.
26.
go back to reference McCullough JP, Schramm E, Penberthy JK. CBASP as a distinctive treatment for persistent depressive disorder. London and New York: Routledge; 2015. McCullough JP, Schramm E, Penberthy JK. CBASP as a distinctive treatment for persistent depressive disorder. London and New York: Routledge; 2015.
27.
go back to reference Wells A. Metacognitive therapy for anxiety and depression. New York: Guilford Press; 2009. Wells A. Metacognitive therapy for anxiety and depression. New York: Guilford Press; 2009.
28.
go back to reference Roniger A, Späth C, Schweiger U, Klein JP. A psychometric evaluation of the German version of the quick inventory of depressive symptomatology (QIDS-SR16) in outpatients with depression. Fortschritte Neurol Psychiatr. 2015;83:17–22.CrossRef Roniger A, Späth C, Schweiger U, Klein JP. A psychometric evaluation of the German version of the quick inventory of depressive symptomatology (QIDS-SR16) in outpatients with depression. Fortschritte Neurol Psychiatr. 2015;83:17–22.CrossRef
29.
go back to reference Klein JP, Belz M. Psychotherapie chronischer depression: Praxisleitfaden CBASP. Göttingen: Hogrefe; 2014. Klein JP, Belz M. Psychotherapie chronischer depression: Praxisleitfaden CBASP. Göttingen: Hogrefe; 2014.
30.
go back to reference Faßbinder E, Klein JP, Sipos V, Schweiger U. Therapie-Tools Depression. 1. Auflage. Weinheim Basel: Beltz; 2015. Faßbinder E, Klein JP, Sipos V, Schweiger U. Therapie-Tools Depression. 1. Auflage. Weinheim Basel: Beltz; 2015.
31.
go back to reference Klein JP, Kensche M, Becker-Hingst N, Stahl J, Späth C, Mentler T, et al. Development and psychometric evaluation of the interactive test of interpersonal behavior (ITIB): a pilot study examining interpersonal deficits in chronic depression. Scand J Psychol. 2016;57:83–91.CrossRef Klein JP, Kensche M, Becker-Hingst N, Stahl J, Späth C, Mentler T, et al. Development and psychometric evaluation of the interactive test of interpersonal behavior (ITIB): a pilot study examining interpersonal deficits in chronic depression. Scand J Psychol. 2016;57:83–91.CrossRef
32.
go back to reference Klein JP, Stahl J, Hüppe M, McCullough JP, Schramm E, Ortel D, Sondermann S, Schröder J, Moritz S, Schweiger U. Do interpersonal fears mediate the association between childhood maltreatment and interpersonal skills deficits? A matched cross-sectional analysis. Psychother Res. 2018. https://doi.org/10.1080/10503307.2018.1532125. Epub ahead of print. Klein JP, Stahl J, Hüppe M, McCullough JP, Schramm E, Ortel D, Sondermann S, Schröder J, Moritz S, Schweiger U. Do interpersonal fears mediate the association between childhood maltreatment and interpersonal skills deficits? A matched cross-sectional analysis. Psychother Res. 2018. https://​doi.​org/​10.​1080/​10503307.​2018.​1532125. Epub ahead of print.
33.
go back to reference Bech P, Gram LF, Dein E, Jacobsen O, Vitger J, Bolwig TG. Quantitative rating of depressive states. Acta Psychiatr Scand. 1975;51:161–70.CrossRef Bech P, Gram LF, Dein E, Jacobsen O, Vitger J, Bolwig TG. Quantitative rating of depressive states. Acta Psychiatr Scand. 1975;51:161–70.CrossRef
34.
go back to reference Bech P. Rating scales for mood disorders: applicability, consistency and construct validity. Acta Psychiatr Scand. 1988;78:45–55.CrossRef Bech P. Rating scales for mood disorders: applicability, consistency and construct validity. Acta Psychiatr Scand. 1988;78:45–55.CrossRef
35.
go back to reference Lalkhen AG, McCluskey A. Clinical tests: sensitivity and specificity. Contin Educ Anaesth Crit Care Pain. 2008;8:221–3.CrossRef Lalkhen AG, McCluskey A. Clinical tests: sensitivity and specificity. Contin Educ Anaesth Crit Care Pain. 2008;8:221–3.CrossRef
36.
go back to reference Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.CrossRef Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.CrossRef
37.
go back to reference Kraemer HC, Kupfer DJ, Clarke DE, Narrow WE, Regier DA. DSM-5: how reliable is reliable enough? Am J Psychiatry. 2012;169:13–5.CrossRef Kraemer HC, Kupfer DJ, Clarke DE, Narrow WE, Regier DA. DSM-5: how reliable is reliable enough? Am J Psychiatry. 2012;169:13–5.CrossRef
38.
go back to reference Byrt T, Bishop J, Carlin JB. Bias, prevalence and kappa. J Clin Epidemiol. 1993;46:423–9.CrossRef Byrt T, Bishop J, Carlin JB. Bias, prevalence and kappa. J Clin Epidemiol. 1993;46:423–9.CrossRef
39.
40.
go back to reference Jaeschke R, Guyatt GH, Sackett DL, Guyatt G, Bass E, Brill-Edwards P, et al. Users’ guides to the medical literature: III. How to use an article about a diagnostic test B. what are the results and will they help me in caring for my patients? J Am Med Assoc. 1994;271:703–7.CrossRef Jaeschke R, Guyatt GH, Sackett DL, Guyatt G, Bass E, Brill-Edwards P, et al. Users’ guides to the medical literature: III. How to use an article about a diagnostic test B. what are the results and will they help me in caring for my patients? J Am Med Assoc. 1994;271:703–7.CrossRef
41.
go back to reference Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.CrossRef Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.CrossRef
42.
go back to reference U.S. Preventive Services Task Force. Screening for depression in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2009;151:784–792. U.S. Preventive Services Task Force. Screening for depression in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2009;151:784–792.
43.
go back to reference Sim J, Wright CC. The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther. 2005;85:257–68.PubMed Sim J, Wright CC. The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther. 2005;85:257–68.PubMed
44.
go back to reference tpdelLöwe B, Spitzer RL, Gräfe K, Kroenke K, Quenter A, Zipfel S, et al. Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. J Affect Disord. 2004;78:131–40. tpdelLöwe B, Spitzer RL, Gräfe K, Kroenke K, Quenter A, Zipfel S, et al. Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. J Affect Disord. 2004;78:131–40.
45.
go back to reference Saipanish R, Lotrakul M, Sumrithe S. Reliability and validity of the Thai version of the WHO-five well-being index in primary care patients. Psychiatry Clin Neurosci. 2009;63:141–6.CrossRef Saipanish R, Lotrakul M, Sumrithe S. Reliability and validity of the Thai version of the WHO-five well-being index in primary care patients. Psychiatry Clin Neurosci. 2009;63:141–6.CrossRef
46.
go back to reference Späth C, Hapke U, Maske U, Schröder J, Moritz S, Berger T, et al. Characteristics of participants in a randomized trial of an internet intervention for depression (EVIDENT) in comparison to a national sample (DEGS1). Internet Interv. 2017;9:46–50.CrossRef Späth C, Hapke U, Maske U, Schröder J, Moritz S, Berger T, et al. Characteristics of participants in a randomized trial of an internet intervention for depression (EVIDENT) in comparison to a national sample (DEGS1). Internet Interv. 2017;9:46–50.CrossRef
47.
go back to reference Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med. 1997;12:439–45.CrossRef Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med. 1997;12:439–45.CrossRef
Metadata
Title
Psychometric evaluation of a screening question for persistent depressive disorder
Authors
Elisa Brinkmann
Sarah Glanert
Michael Hüppe
Ana Sofia Moncada Garay
Sophie Tschepe
Ulrich Schweiger
Jan Philipp Klein
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2019
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-019-2100-0

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