Depression Screening Tools for Patients with Kidney Failure A Systematic Review

Background and objectives Patients with kidney failure experience depression at rates higher than the general population. Despite the Centers for Medicare and Medicaid Services' ESRD Quality Incentive Program requirements for routine depression screening for patients with kidney failure, no clear guidance exists. Design, setting, participants,& measurements For this systematic review, we searchedMEDLINE, PsycINFO, and other databases from inception to June 2020. Two investigators screened all abstracts and full text. We included studies assessing patientswith kidney failure and compared a tool to a clinical interviewor another validated tool (e.g., BeckDepression Inventory II). We abstracted data related to sensitivity and specificity, positive and negative predictive value, and the area under the curve. We evaluated the risk of bias using the Quality Assessment of Diagnostic Accuracy Studies 2. Results Atotal of 16 studies evaluated the performance characteristics of depression assessment tools for patients with kidney failure. The BeckDepression Inventory IIwas by far the best studied. Awide range of thresholdswere reported. Shorter tools in the public domain such as the Patient Health Questionnaire 9 and Geriatric Depression Scale 15 (adults over 60) performed well but were not well studied. Short tools such as the Beck Depression Inventory-Fast Screen may be a good option for an initial screen. Conclusions There is limited research evaluating the diagnostic accuracy ofmost screening tools for depression in patientswith kidney failure, and existing studies may not be generalizable toUS populations. Studies suffer from limitations related tomethodology quality and/or reporting. Future research shouldtarget widely used, free tools such as the Patient Health Questionnaire 2 and the Patient Health Questionnaire 9.