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

Published online by Cambridge University Press:  27 March 2019

Andrew G. B. Thompson
Affiliation:
Department of Neurology, University College London, London, UK
Rollo Sheldon
Affiliation:
Department of Neuropsychiatry, South West London and St George’s Mental Health NHS Trust, London, UK
Norman Poole
Affiliation:
Department of Neuropsychiatry, South West London and St George’s Mental Health NHS Trust, London, UK
Rita Varela
Affiliation:
Department of Neuropsychiatry, South West London and St George’s Mental Health NHS Trust, London, UK Department of Psychiatry, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
Sarah White
Affiliation:
Atkinson Morley Regional Neuroscience Centre, St George’s University Hospitals NHS Foundation Trust, London, UK
Paula Jones
Affiliation:
Atkinson Morley Regional Neuroscience Centre, St George’s University Hospitals NHS Foundation Trust, London, UK
Carole Mulley
Affiliation:
Atkinson Morley Regional Neuroscience Centre, St George’s University Hospitals NHS Foundation Trust, London, UK
Amy Berg
Affiliation:
Atkinson Morley Regional Neuroscience Centre, St George’s University Hospitals NHS Foundation Trust, London, UK
Camilla R. V. Blain
Affiliation:
Atkinson Morley Regional Neuroscience Centre, St George’s University Hospitals NHS Foundation Trust, London, UK Institute of Medical & Biomedical Education, St George's University of London, London, UK
Niruj Agrawal*
Affiliation:
Department of Neuropsychiatry, South West London and St George’s Mental Health NHS Trust, London, UK Institute of Medical & Biomedical Education, St George's University of London, London, UK
*
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

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.

Type
Original Article
Copyright
© Scandinavian College of Neuropsychopharmacology 2019 

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Footnotes

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

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