The median prevalence of Major Depression was % (IQ range from . both sensitivity and specificity and the relationship between them. To find the sensitivity and specificity of DoloTest as a screening tool for Pain is also associated with increased prevalence of depressive disorders [5, 6]. and understanding of this connection between depression and pain. Sensitivity and specificity are not generally related to the prevalence of the disease in PPV, NPV, NNT and NNH all will change with a difference in prevalence .. Suppose that you wish to validate a depression rating scale and you choose a.
Results 28 studies 10, participants met eligibility criteria.
The median prevalence of Major Depression was 8. The overall area under the curve was 0. At the cut-off 16, sensitivity was 0.
None of the variables assessed as possible sources of heterogeneity was found to be statistically significant. Conclusion The CES-D has acceptable screening accuracy in the general population or primary care settings, but it should not be used as an isolated diagnostic measure of depression.
Depending on the test objectives, the cut-off 20 may be more adequate than the value of 16, which is typically recommended. Introduction Major Depression ranks amongst the most burdensome health conditions, both at individual and population levels [ 1 — 3 ].
It is also associated with a substantial functional impairment, diminished quality of life, increased burden, both for patients and caregivers, as well as with a higher risk of mortality [ 4 — 6 ].
Depression screening would also be important in primary care and general population settings for monitoring disease prevalence [ 12 ], as well as for targeting interventions at either individual or group level. Therefore, there is an increasing need for evidence about the accuracy the ability to discriminate between people with the disorder and those without it of different assessment methods.
A number of excellent exhaustive diagnostic instruments exist for depression diagnosis i. Using such instruments is also unattainable in clinical applications with stringent time-demands, and thus outside specialized mental health care services.
In contrast, brief, self-reported scales are economical, can be readily applied requiring neither extensive training nor time, and have been found to be sensitive to changes over time. Several short scales have been developed to ascertain the presence of depression in general population surveys and primary care samples [ 13 ].
Originally devised for screening and research in general population epidemiological studies and primary care, the CES-D has also been extensively used in other settings, as a measure of depressive symptomatology among individuals with specific chronic conditions [ 15 ; 16 ], and even as a stand-alone diagnostic measure of depression [ 17 — 19 ]. A simple search in bibliographic databases retrieves thousands of population-based and clinical studies using the CES-D in the last ten years.
A number of these studies have evaluated the diagnostic accuracy of the CES-D to detect major depression at the general population and primary care levels.
DoloTest in General Practice Study: Sensitivity and Specificity Screening for Depression
In spite of its prominence, no work has been done to date to integrate the results on its performance through meta-analysis. A meta-analytic approach would be important for the CES-D, since it would provide precise and generalizable evidence about the performance of the CES-D and the interpretation of its results, and to establish whether and how associated findings vary by particular subgroups [ 20 ; 21 ].
Aims of the study The aim of our study was to collect and analyse all the existing evidence regarding the performance of the CES-D scale to detect major depression in general populations and primary care. This was done through: It contains 20 items about symptoms that occurred in the week prior to the interview with response options from 0 to 3 that refer to frequency of the symptoms. The score ranges between 0 best possible to 60 worst and the cut-off point that has been typically recommended for depression caseness is 16 [ 22 ].
Individuals with a score of 16 or more must have had either at least 6 of the 20 symptoms in the CES-D with persistence for most of the previous week, or a majority of the symptoms on the scale for shorter periods of time.
CES-D literacy level has been defined as easy, and it takes between 2 and 5 minutes to complete. Search terms included three components that had to be fulfilled. Finally, the third component had to do with the assessment of the diagnostic accuracy of the instruments including terms related with validation studies, like ROC analysis or sensitivity and specificity.
The search strategy applied in PubMed is available in S1 Table. Selection of eligible studies This study was part of a larger project that aimed to examine test characteristics of frequently used screening instruments for common mental disorders, with special interest in the CES-D and the General Health Questionnaire GHQ. Even though the search strategy was open to all the screening instruments available for mood or anxiety disorders, in this particular work we exclusively focus on the studies identified that used the CES-D scale.
Studies were eligible if they met all of the following inclusion criteria: Studies were excluded if: Each participant was given a survey pack, which includes information for the participant, informed consent form, and the questionnaire itself. In the questionnaire, information on gender, age, social factors income, living conditions, marital status, level of education, employment, and the nature of workthe presence or absence of chronic diseases, and the presence of physical activity was collected.
Historically, the situation is that the indigenous population, as well as other non-Russian residents of Central Kazakhstan, is fluent in Russian. It was specifically developed for use, in primary care general medical settings. The PHQ-9 offers several advantages to other tools.
The tool is easily understood with very high face validity for patients and clinicians in primary care, because the items and the scoring of items on the PHQ-9 are identical to the symptoms and signs of DSM-4 major depression. Many other instruments use a 1-week time frame, but the PHQ-9 uses a 2-week time frame, which conforms to DSM-4 criteria. It is the only tool that was specifically developed for use as a patient self-administered depression diagnostic tool, rather than as a severity or screening tool.
It is the only short self-report tool that can reasonably be used both for the diagnosis of DSM-4 major depression and for the tracking of the severity of major depression over time.
The questionnaire consists of nine points with a four-point scale evaluation absence of symptoms, some days, more than half the days, and almost every dayallowing for a diagnosis of depression occurring in the previous two weeks to be made for those scoring in the range of 0—27 points. The sum of points from 1—4 was regarded as minimal depressive symptom severity, 5—9 mild, 10—14 moderate, 15—19 severe, and 20—27 extremely severe depressive symptom.
Subjects From a public health department of two cities and two rural districts of the Karaganda Region, general registries were obtained. To make a random sample from those registries, every second record was taken. Invitations for those people were sent by phone. During two weeks, respondents arrived to surveying. Each of the possible participants was informed by the research team. Of these, of the respondents, aged 25 to 65, gave informed consent to participate in the research and were fluent in Russian; these individuals were included in the study.
Among them, were living in urban areas and in rural. The exclusion criteria included being pregnant or having a mental or severe neurological disease. A total of people were excluded from the study due to different reasons: Statistical Methods We used cross-tabulations to assess the prevalence of depressive symptoms in different sociodemographic groups.
The statistical significance of differences was assessed using a chi-square test. The relative risk of the depressive symptoms under the influence of social-demographic factors was evaluated by ordinal logistic regression. The significance of the impact from each attribute on the level of depressive symptoms was assessed using the Wald test. Logistic regression coefficients and the impact of attributes on the probability of depressive symptom level in the form of odds ratios OR were calculated.
Odds ratios were evaluated relative to a reference group. Results and Discussion General characteristics of contingent subjects are presented in Table 1. General characteristics of the contingent. The results showed that Depressive symptomatology frequencies according to sociodemographic and behavioral factors are presented in Table 2. Prevalence of depressive symptoms in different sociodemographic groups.
DoloTest in General Practice Study: Sensitivity and Specificity Screening for Depression
Depressive Symptoms and Gender As the depressive symptoms increase, the gender differences reduce: Depressive Symptoms and Age There were no significant differences in the prevalence of depressive symptoms depending on age; although the highest percentage of persons who had no depressive symptomatology was observed in the age group 36—45 years Depressive Symptoms and the Marital Status The lack of depressive symptoms was more frequently registered among persons who had not married or those who were then married Depressive Symptoms and Education Although the results showed that differences in the prevalence of depressive symptoms depend on the level of education, this relationship was nonlinear.
The lowest frequency of moderate, severe, and very severe depressive symptomatology cases was observed in persons with higher levels of education. Depressive Symptoms, Employment, and the Nature of Labor Differences were noted in the incidence of depressive symptomatology, depending on the nature of employment and labor. Depressive Symptoms and Income The rate of depressive symptoms existed to varying degrees among groups of respondents with different income levels.
Depressive Symptoms and Chronic Illness The presence of a chronic disease increases the incidence of depressive symptomatology, regardless of its severity. Depressive Symptoms and Physical Activity The frequency of depressive symptoms had a significant difference among those who did and did not engage in physical activity. Table 3 illustrates the results of the attribute evaluation using an ordinal logistic regression.
According to these data, in females, the probability of depressive symptoms in 1. The OR in persons of Russian nationality compared with Kazakh is 1.
Also, depressive symptom risk factors include financial income below average, low physical activity, and the presence of chronic diseases. In the obtained model of ordinal regression, all these factors turned out to be statistically significant. Estimation of ordinal logistic regression parameters. As noted above, we did not receive statistically significant differences in the prevalence of depressive symptoms in different age groups. The results of regression analysis also indicate that age is not a risk factor.
We have not found any information on the depressive symptom prevalence in Kazakhstan in any available literature. In the current study, a higher rate of depressive symptomatology was observed in women compared to men, which has been supported by many studies. It can be assumed that the differences according to sex are due to the greater willingness of women to discuss their psychological problems and a more positive attitude in general to mental disorders compared to the tendencies of men [ 16 — 18 ].
There are prejudices that exist related to the stigma associated with depression, and these may be less important for women than for men [ 19 ]; thus, women are more willing to accept the presence of depression [ 20 — 22 ]. Lower levels of bias and prejudice against the presence of depressive symptoms among women may explain the greater incidence of depression compared with men.
Health and physical activity are important factors that have an impact on depressive symptomatology. We revealed the fact that among persons with chronic diseases, depressive symptoms are more common, than among the healthy people. These data are consistent with other studies that have shown that the relationship between depression and chronic diseases illustrates a mutually burdening character.