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A new way of rapidly screening for depression in multiple sclerosis using Emotional Thermometers

  • Andrew G. B. Thompson (a1), Rollo Sheldon (a2), Norman Poole (a2), Rita Varela (a2) (a3), Sarah White (a4), Paula Jones (a4), Carole Mulley (a4), Amy Berg (a4), Camilla R. V. Blain (a4) (a5) and Niruj Agrawal (a2) (a5)...

Abstract

Objective

Depression is a common, serious, but under-recognised problem in multiple sclerosis (MS). The primary objective of this study was to assess whether a rapid visual analogue screening tool for depression could operate as a quick and reliable screening method for depression, in patients with MS.

Method

Patients attending a regional MS outpatient clinic completed the Emotional Thermometer 7 tool (ET7), the Hospital Anxiety and Depression Scale – Depression Subscale (HADS-D) and the Major Depression Inventory (MDI) to establish a Diagnostic and Statistical Manual, 4th edition (DSM-IV) diagnosis of Major Depression. Full ET7, briefer subset ET4 version and depression and distress thermometers alone were compared with HADS-D and MDI. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and receiver operating characteristic (ROC) curve were calculated to compare the performance of all the screening tools.

Results

In total, 190 patients were included. ET4 performed well as a ‘rule-out’ screening step (sensitivity 0.91, specificity 0.72, NPV 0.98, PPV 0.32). ET4 performance was comparable to HADS-D (sensitivity 0.96, specificity 0.77, NPV 0.99, PPV 0.37) without need for clinician scoring. The briefer ET4 performed as well as the full ET7.

Conclusion

ET are quick, sensitive and useful screening tools for depression in this MS population, to be complemented by further questioning or more detailed psychiatric assessment where indicated. Given that ET4 and ET7 perform equally well, we recommend the use of ET4 as it is briefer. It has the potential to be widely implemented across busy neurology clinics to assist in depression screening in this under diagnosed group.

Copyright

Corresponding author

Author for correspondence: Niruj Agrawal, South West London and St George’s Mental Health NHS Trust, London, UK. Tel: 0044 208 725 3786; Fax: 0044 208 725 2929; E-mail: niruj.agrawal@swlstg.nhs.uk

Footnotes

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Andrew G. B. Thompson and Rollo Sheldon are joint first authors and have contributed equally to this work.

Footnotes

References

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