Danielle B. Rice

Risk of Bias from Inclusion of Currently Diagnosed or Treated Patients in Studies of Depression Screening Tool Accuracy: A Cross-Sectional Analysis of Recently Published Primary Studies and Meta-Analyses

Background Depression screening can improve upon usual care only if screening tools accurately identify depressed patients who would not otherwise be recognized by healthcare providers. Inclusion of patients already being treated for depression in studies of screening tool accuracy would inflate estimates of screening accuracy and yield. The present study investigated (1) the proportion of primary studies of depression screening tool accuracy that were recently published in journals listed in MEDLINE, which appropriately excluded currently diagnosed or treated patients; and (2) whether recently published meta-analyses identified the inclusion of currently diagnosed or treated patients as a potential source of bias. Methods MEDLINE was searched from January 1, 2013 through March 27, 2015 for primary studies and meta-analyses on depression screening tool accuracy. Results Only 5 of 89 (5.6%) primary studies excluded currently diagnosed or treated patients from any analyses and only 3 (3.4%) from main analyses. In 3 studies that reported the number of patients excluded due to current treatment, the number of excluded patients was more than twice the number of newly identified depression cases. None of 5 meta-analyses identified the inclusion of currently diagnosed and treated patients as a potential source of bias. Conclusions The inclusion of currently diagnosed and treated patients in studies of depression screening tool accuracy is a problem that limits the applicability of research findings for actual clinical practice. Studies are needed that evaluate the diagnostic accuracy of depression screening tools among only untreated patients who would potentially be screened in practice.

Perceived Benefits and Factors that Influence the Ability to Establish and Maintain Patient Support Groups in Rare Diseases: A Scoping Review

BackgroundSupport groups are an important resource for many people living with rare diseases. The perceived benefits of participating in support groups for people with rare diseases and factors that may influence the ability to successfully establish and maintain these groups are not well understood. Thus, the objective of this scoping review was to provide a mapping of the available evidence on the (1) benefits or perceived benefits of participating in rare disease support groups and (2) barriers and facilitators of establishing and maintaining these groups.MethodsCINAHL and PubMed were searched from January 2000 to August 2015, with no language restrictions. Publications that described the benefits or perceived benefits of participating in rare disease support groups or the barriers and facilitators of establishing and maintaining them were eligible for inclusion. Two investigators independently evaluated titles/abstracts and full-text publications for eligibility, and extracted data from each included publication.ResultsTen publications were included in the scoping review. There was no trial evidence on support group benefits. All ten publications reported on the perceived benefits of participating in rare disease support groups. Three reported on barriers and facilitators of establishing and maintaining them. Overall, seven different perceived benefits of participating in rare disease support groups were identified: (1) meeting and befriending other people with the same rare disease and similar experiences; (2) learning about the disease and related treatments; (3) giving and receiving emotional support; (4) having a place to speak openly about the disease and one’s feelings; (5) learning coping skills; (6) feeling empowered and hopeful; and (7) advocating to improve healthcare for other rare disease patients. Several facilitators (e.g., meeting via teleconference) and barriers (e.g., getting patients and/or family members to lead the group) of establishing and maintaining these groups were identified.ConclusionsRare disease support groups are an important source of emotional and practical support for many patients. There is no trial evidence on the benefits of these groups and limited evidence on the perceived benefits and barriers and facilitators to establishing and maintaining them.

Sample sizes and precision of estimates of sensitivity and specificity from primary studies on the diagnostic accuracy of depression screening tools: a survey of recently published studies.

Depression screening tools are useful to the extent that they accurately discriminate between depressed and non‐depressed patients. Studies without enough patients to generate precise estimates make it difficult to evaluate accuracy. We conducted a survey of recently published studies on depression screening tool accuracy to evaluate the percentage with sample size calculations; the percentage that provided confidence intervals; and precision, based on the width and lower bounds of 95% confidence intervals for sensitivity and specificity. We calculated 95% confidence intervals, if possible, when not provided. Only three of 89 studies (3%) described a viable sample size calculation. Only 30 studies (34%) provided reasonably accurate confidence intervals. Of 86 studies where 95% confidence intervals were provided or could be calculated, only seven (8%) had interval widths for sensitivity of ≤ 10%, whereas 53 (62%) had widths of ≥ 21%. Lower bounds of confidence intervals were < 80% for 84% of studies for sensitivity and 66% of studies for specificity. Overall, few studies on the diagnostic accuracy of depression screening tools reported sample size calculations, and the number of patients in most studies was too small to generate reasonably precise accuracy estimates. The failure to provide confidence intervals in published reports may obscure these shortcomings. Copyright

Reporting completeness and transparency of meta-analyses of depression screening tool accuracy: A comparison of meta-analyses published before and after the PRISMA statement.

OBJECTIVE Meta-analyses that are conducted rigorously and reported completely and transparently can provide accurate evidence to inform the best possible healthcare decisions. Guideline makers have raised concerns about the utility of existing evidence on the diagnostic accuracy of depression screening tools. The objective of our study was to evaluate the transparency and completeness of reporting in meta-analyses of the diagnostic accuracy of depression screening tools using the PRISMA tool adapted for diagnostic test accuracy meta-analyses. METHODS We searched MEDLINE and PsycINFO from January 1, 2005 through March 13, 2016 for recent meta-analyses in any language on the diagnostic accuracy of depression screening tools. Two reviewers independently assessed the transparency in reporting using the PRISMA tool with appropriate adaptations made for studies of diagnostic test accuracy. RESULTS We identified 21 eligible meta-analyses. Twelve of 21 meta-analyses complied with at least 50% of adapted PRISMA items. Of 30 adapted PRISMA items, 11 were fulfilled by ≥80% of included meta-analyses, 3 by 50-79% of meta-analyses, 7 by 25-45% of meta-analyses, and 9 by <25%. On average, post-PRISMA meta-analyses complied with 17 of 30 items compared to 13 of 30 items pre-PRISMA. CONCLUSIONS Deficiencies in the transparency of reporting in meta-analyses of the diagnostic test accuracy of depression screening tools of meta-analyses were identified. Authors, reviewers, and editors should adhere to the PRISMA statement to improve the reporting of meta-analyses of the diagnostic accuracy of depression screening tools.

Are MEDLINE searches sufficient for systematic reviews and meta-analyses of the diagnostic accuracy of depression screening tools? A review of meta-analyses

OBJECTIVE Database searches for studies of diagnostic test accuracy are notoriously difficult to filter, highly resource-intensive, and a potential barrier to quality evidence synthesis. We examined published meta-analyses of depression screening tool accuracy to evaluate the (1) proportion of included primary studies found in any online database in the original meta-analyses that were indexed in MEDLINE; (2) the proportion of patients from MEDLINE-indexed studies; and (3) the proportion of depression cases from studies indexed in MEDLINE. METHODS MEDLINE and PsycINFO were searched from January 1, 2005 through October 31, 2014 for meta-analyses in any language on the accuracy of depression screening tools. RESULTS We identified 16 eligible meta-analyses that included 398 primary study citations, which had been identified via an online database in the original meta-analyses, including 257 unique citations and 234 unique patient samples. The 234 unique patient samples included 69,957 total patients and 11,867 depression cases. Of these, 220 samples (94%) were from studies indexed in MEDLINE, including 97% of all patients and 96% of all depression cases. When applying a peer-reviewed search strategy in MEDLINE, 91% of all samples, 96% of patients and 95% of depression cases were retrieved. Results were similar for total and unique citations. CONCLUSIONS Restricting searches to MEDLINE may capture almost all eligible studies, patients and depression cases. Although not examined in the present study, MEDLINE may not be indexed as quickly as other databases. Thus, MEDLINE searches should be complemented by date-limited searches of other databases for recent citations.

Using Marital Status and Continuous Marital Satisfaction Ratings to Predict Depressive Symptoms in Married and Unmarried Women With Systemic Sclerosis: A Canadian Scleroderma Research Group Study

Married persons have, on average, better mental health than nonmarried persons. Among married persons, marital satisfaction is associated with better mental health. Studies on mental health in married and nonmarried persons that consider marital satisfaction have categorized patients as satisfied versus unsatisfied, which reduces statistical power and does not generate clinically useful information on mental health across the satisfaction spectrum. Our objective was to demonstrate a novel regression approach to evaluate mental health in women with systemic sclerosis (SSc), comparing married and unmarried women, accounting for continuously measured marital satisfaction.

Exercise habits and factors associated with exercise in systemic sclerosis: a Scleroderma Patient-centered Intervention Network (SPIN) cohort study

Abstract Objective: Exercise is associated with improved health in many medical conditions. Little is known about the exercise habits of people with systemic sclerosis (SSc, or scleroderma). This study assessed the proportion of individuals with SSc who exercise and associations of demographic and disease variables with exercise. Additionally, the weekly amount of time spent exercising and the types of exercise performed were assessed among patients exercising. Methods: The sample consisted of adult participants with SSc enrolled in the Scleroderma Patient-centered Intervention Network (SPIN) Cohort who completed baseline questionnaires from March 2014 through August 2015. Baseline questionnaires included questions on exercise habits, physician-reported medical characteristics, self-report demographic characteristics, the Health Assessment Questionnaire-Disability Index, Patient Health Questionnaire-9, and Patient-Reported Outcomes Measurement Information System-29. Results: Of 752 patients, 389 (51.7%) reported presently engaging in exercise, and these patients exercised on average 4.7 h [standard deviation (SD) = 2.8] per week. Among patients who reported exercising, walking was most commonly reported (n = 295, 75.8%). In bivariate analyses, present exercise was associated with more education, lower body mass index, some (versus no) alcohol consumption, non-smoking, limited/sine disease subtype, absence of skin thickening, lower disability, higher physical function, lower symptoms of anxiety and depression, less fatigue, lower sleep disturbance, higher ability to participate in social roles and activities, and less pain. Conclusions: Approximately half of SSc patients reported that they are currently exercising with walking being the most common form of exercise. Understanding exercise patterns and factors associated with exercise will help better inform intervention programs to support exercise for patients with SSc. Implications for rehabilitation Systemic sclerosis is a rare autoimmune rheumatic disease associated with great morbidity and highly diverse presentation. Approximately half of people with both limited and diffuse systemic sclerosis report exercising. Most exercisers walk, but patients engage in a wide variety of exercise-related activities. Individually designed exercise programs are most likely to support and encourage exercise in patients with diverse disease manifestations.

Probability of major depression diagnostic classification using semi-structured versus fully structured diagnostic interviews

BACKGROUND Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.AimsTo evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics. METHOD Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit. RESULTS A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15-3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98-10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7-15) (OR = 0.96; 95% CI = 0.56-1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26-0.97). CONCLUSIONS The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.Declaration of interestDrs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

Reporting quality in abstracts of meta-analyses of depression screening tool accuracy: a review of systematic reviews and meta-analyses

Objective Concerns have been raised regarding the quality and completeness of abstract reporting in evidence reviews, but this had not been evaluated in meta-analyses of diagnostic accuracy. Our objective was to evaluate reporting quality and completeness in abstracts of systematic reviews with meta-analyses of depression screening tool accuracy, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for Abstracts tool. Design Cross-sectional study. Inclusion Criteria We searched MEDLINE and PsycINFO from 1 January 2005 through 13 March 2016 for recent systematic reviews with meta-analyses in any language that compared a depression screening tool to a diagnosis based on clinical or validated diagnostic interview. Data extraction Two reviewers independently assessed quality and completeness of abstract reporting using the PRISMA for Abstracts tool with appropriate adaptations made for studies of diagnostic test accuracy. Bivariate associations of number of PRISMA for Abstracts items complied with (1) journal abstract word limit and (2) A Measurement Tool to Assess Systematic Reviews (AMSTAR) scores of meta-analyses were also assessed. Results We identified 21 eligible meta-analyses. Only two of 21 included meta-analyses complied with at least half of adapted PRISMA for Abstracts items. The majority met criteria for reporting an appropriate title (95%), result interpretation (95%) and synthesis of results (76%). Meta-analyses less consistently reported databases searched (43%), associated search dates (33%) and strengths and limitations of evidence (19%). Most meta-analyses did not adequately report a clinically meaningful description of outcomes (14%), risk of bias (14%), included study characteristics (10%), study eligibility criteria (5%), registration information (5%), clear objectives (0%), report eligibility criteria (0%) or funding (0%). Overall meta-analyses quality scores were significantly associated with the number of PRISMA for Abstracts scores items reported adequately (r=0.45). Conclusions Quality and completeness of reporting were found to be suboptimal. Journal editors should endorse PRISMA for Abstracts and allow for flexibility in abstract word counts to improve quality of abstracts.

Reducing Waste and Increasing the Usability of Psychiatry Research: The Family of EQUATOR Reporting Guidelines and One of Its Newest Members: The PRISMA-DTA Statement

In Canada, our provincial and territorial health systems are increasingly challenged to meet the needs of patients, including mental health needs. Research is needed to find ways to provide more effective and efficient care. Waste in research, however, presents a formidable barrier to achieving this. One important source of waste in research is the incomplete and inaccurate reporting of published research results. Poor and inaccurate reporting pose substantial barriers to effectively translating research into improved patient care, both in psychiatry and other areas of medicine. Assessing the utility and applicability of published findings requires an understanding of what actually occurred in a study and knowledge of the study’s complete set of results. This information, however, is often either not provided in published study reports or is not provided with enough clarity to be useful. As a result, billions of dollars in research funding are wasted every year, and the risk of inadequate and misinformed care is needlessly heightened. Biomedical research reporting guidelines have been developed with the goal of increasing the value and quality of research. These guidelines typically describe a minimum set of information that should be clearly reported, provide examples of guideline-consistent reporting, and include a checklist to facilitate compliance. The first Consolidated Standards of Reporting Trials (CONSORT) statement on the reporting of parallel group randomized controlled trials was published in 1996. The EQUATOR (Enhancing the QUAlity and Transparency Of health Research) initiative, which grew out of the work of CONSORT and other groups, was founded in 2008 with the mission of improving health research by promoting transparent, accurate, and complete reporting. Other major reporting guidelines that have been developed by EQUATOR include the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement, and the Standards for Reporting of Diagnostic Accuracy (STARD) statement. In recent years, EQUATOR reporting guidelines have expanded to include an extensive list of guidelines intended for specific trial designs (e.g., cluster randomized trials), for reporting specific types of outcomes (e.g., patient-reported outcomes), or for reporting specific types of systematic reviews and meta-analyses, including the Preferred Reporting Items for a Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) statement, among other examples.