Validity of four screening scales for major depression in MS

Scott B. Patten, Jodie M. Burton, Kirsten M. Fiest, Samuel Wiebe, Andrew G.M. Bulloch, Marcus Koch, Keith S. Dobson, Luanne M. Metz, Colleen J. Maxwell, Nathalie Jetté

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74 Scopus citations


Background: There is a role for brief assessment instruments in detection and management of major depression in MS. However, candidate scales have rarely been validated against a validated diagnostic interview. In this study, we evaluated the performance of several candidate scales: Patient Health Questionnaire (PHQ)- 9, PHQ-2, Center for Epidemiologic Studies Depression rating scale (CES-D), and Hospital Anxiety and Depression Scale (HADS-D) in relation to the Structured Clinical Interview for DSM-IV (SCID). Methods: The sample was an unselected series of 152 patients attending a multiple sclerosis (MS) clinic. Participants completed the scales during a clinic visit or returned them by mail. The SCID was administered by telephone within two weeks. The diagnosis of major depressive episode, according to the SCID, was used as a reference standard. Receiver-operator curves (ROC) were fitted and indices of measurement accuracy were calculated. Results: All of the scales performed well, each having an area under the ROC > 90%. For example, the PHQ-9 had 95% sensitivity and 88.3% specificity when scored with a cut-point of 11. This cut-point achieved a 56% positive predictive value for major depression. Conclusions: While all of the scales performed well in terms of their sensitivity and specificity, the availability of the PHQ-9 in the public domain and its brevity may enhance the feasibility of its use.

Original languageEnglish
Pages (from-to)1064-1071
Number of pages8
JournalMultiple Sclerosis Journal
Issue number8
StatePublished - 11 Jul 2015
Externally publishedYes


  • Outcome measurement
  • multiple sclerosis
  • quality of life
  • symptomatic treatment


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