Received Aug 3; Accepted Mar This article has been cited by other articles in PMC. This paper aims to investigate the psychometric proprieties reliability and validity of these scales in a Brazilian sample, and to compare responses in bipolar and unipolar patients. Participants were recruited and treated by clinicians through the Structured Interview for DSM-IV criteria, and had previously been interviewed by a trained, blind tester.
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Abstract Background Clinical assessment of depression is an important part of pre-surgical assessment among individuals with morbid obesity. However, there is no agreed-upon instrument to identify mood psychopathology in this population.
We calculated the sensitivity and specificity of cutoff points of both versions MADRS, and values were plotted as a receiver operating characteristic curve. Following items were removed: reduced appetite, reduced sleep, concentration difficulties, suicide thought and lassitude. The 5-item version showed an alpha coefficient of 0. Conclusion The MADRS is a reliable and valid instrument to assess depressive symptoms among treatment-seeking bariatric patients.
Systematic application of the abbreviated version of the MADRS can be recommended for enhancing the clinical detection of depression during perioperative period. Peer Review reports Background Depression and obesity are onerous non-communicable conditions that frequently coexist [ 1 ].
Potential bi-directional relationship between obesity and depression is observed and possible causal relationship between these conditions is suggested [ 4 ].
Although pre-surgery depression alone has not been shown to be a robust outcome predictor of post-operative weight loss [ 5 ], its presence in pre-surgical period can contraindicate bariatric procedure [ 6 ]. Therefore, the accurate identification of psychopathology is a crucial step in these patients. Most of bariatric clinicians acknowledge that depression should be treated and stabilized before surgery, but there are problems in its detection. Non-recognition of depressive symptoms can result in misdiagnosis [ 7 ] and unreliable judgment of surgical eligibility [ 8 ].
Moreover, many patients tend to present themselves in positive light during psychosomatic evaluations, highlighting somatic symptoms to meet medical expectations and clinical guidelines of pre-surgical assessment. This impression management represents an effort to control or influence the perceptions of healthcare staff in the approval process [ 6 , 9 ].
The performance of symptomatic scales of depression can be altered when somatic and cognitive symptoms co-occur alongside of depressive symptoms [ 9 ], what can also lead to misclassification and mistakes in surgical indication. While overdetection of depression can increase disapprovals to bariatric surgery [ 6 , 9 ], its underdetection can cause unfavorable outcome among unrecognized depressive patients in post-surgical periods [ 10 ]. Thus, the adoption of accurate methods displaying acceptable sensitivity and specificity to identify perioperative psychopathology can reduce the burden of depression among bariatric patients [ 11 ].
Some popular instruments for detection of depression were used in this population, e. Most of tools are self-administered for screening depression and some researchers claim that these scales are conceptually flawed for use in specific settings and patients [ 9 , 13 , 26 ], with several psychometric limitations e. Among available self-report scales, the BDI is the most common one reported with the purpose of pre-surgical screening for depression among obese populations [ 9 , 15 — 20 ].
The HADS does not include somatic symptoms and is viewed as an easy tool to administer in this population; this instrument has being adopted as indicator of psychopathology in a large prospective Swedish Obese Subjects SOS trial [ 22 ].
Nevertheless, its applicability can be questioned for discriminating depressive illness, as this tool has presented low sensitivity among breast cancer participants [ 26 ]. Structured clinician-administered scales for depression have not been well studied in bariatric population.
Moreover, the decision for choosing MADRS instead of HAM-D eventually rest on consensus that a useful instrument should capture adequately the construct of depression among patient samples [ 11 ], with empirical evidence of psychometric robustness and cost-effectiveness [ 28 ].
Given the need for standardized assessment tools that have validity evidence in bariatric population and clinician-administered scales for depression have not been well studied in this population, we investigated the applicability of the MADRS for a sample of pre-surgical patients in the waiting list of a bariatric clinic. The MADRS has never been applied to preoperative bariatric candidates and incorporates a structured interview embedded in a brief item scale [ 29 ].
We aimed to determine the accuracy of the scale a to estimate its reliability and validity for assessing depression, and b to test whether it is possible to develop a short version of instrument without somatic-cognitive symptoms. Methods This validation study determined the performance of the MADRS for assessing depression among patients seeking bariatric surgery. They were ranked in a waiting list in accordance to admission date in the program and clinical severity. The first eligible patients in the list were consecutively invited by telephone to participate in the study.
After brief explanation, 63 patients declined to participate. The final sample was comprised of individuals, with a participation rate of Of participants, the majority were women The mean schooling was 9. The mean age was Ten symptoms are rated on a 0—6 scale, along the possible scores of 0— The total score classifies the patients in levels of severity: normal or absent 0—6; mild 7—19; moderate 20—34; and severe 35—60 [ 30 ].
The raters were clinical psychologists with experience in bariatric patients, whose scores were calibrated in 3 consensus meetings. Previous psychometric study [ 32 ] reported the intraclass correlation coefficient ICC of the MADRS as acceptable for unipolar depression, ranging between 0. From to , participants were randomly assigned to be face-to-face assessed by trained psychologists with previous experience in obesity and bariatric surgery, with an inter-rater kappa estimated as 0.
The psychiatric diagnoses of this sample can be inspected in Additional file 1 : Table S1. Non-relevant symptoms were eliminated in accordance with following rationale: a clinic wisdom, b item endorsement and c commonality values. To inspect the between-variable structure of correlation, the dimensionality of the MADRS was examined through factor analysis [ 36 ]. All analyses were performed using SPSS version The highest item endorsement rates mean score around 1.
Although women scored higher than men 8. Further analysis showed that The sensitivity and false-positive rates 1 - specificity were used to construct the ROC curve Fig. The area under the curve AUC of 0. In summary, these acceptable results indicated that the MADRS was appropriated for the detection of depression.
We have shown that the MADRS could be used with good confidence, high sensitivity and specificity in this population. Also, this clinician-administered scale could be customized into a short version, preserving robust psychometric properties.
Accurate detection of depression and proper indication of individuals to surgical intervention present a potential impact for public health. Reliable preoperative evaluations may ensure the reproducibility of pre-operative assessments and improve post-operative outcomes [ 6 , 8 ]. Where to place the cut-off point to determine the presence of relevant depressive symptoms is critical to the domain of public health.
The large range of cut-off scores indicates the need of validity investigation to ensure its applicability for specific populations.
Montgomery-Asberg Depression Rating Scale
The impact of this variable on the prevalence of depression has been established in epidemiological studies 44showing that younger people are exposed to a greater risk of madrss disorders such as mood, anxiety and alcohol disorders. The two detecting methods i. Nonetheless, reliability results for short versions indicated that that scales has good sensitivity and specifity scores 23 and HAMD was not sensitive to specify depression symptoms as expected Hospital Universitario Puerta de Hierro. Clinical assessment In order to determine the stability of the condition at baseline visit, all patients were evaluated with the Modified Clinical Global Impression Scale for Bipolar Disorder CGI-BPM 23,24 ; the madrd Hamilton Depression Rating Scale HDRS 27,28 was also administered to record and score any present depressive symptoms and their severity at the time patients were included in the study. How accurate are patients in reporting their antidepressant treatment history?
Escala de Depressão de Montgomery-Asberg - Versão auto-aplicável
Montgomery–Åsberg Depression Rating Scale
MADRS: Escala de clasificación de la depresión de Montgomery-Asberg