Optimizing screening for depression among adults with asthma

Abstract

Objective: The Beck Depression Inventory II (BDI-II) is one of the most frequently used tools to screen for depression in patients with chronic diseases such as cardiovascular disease and asthma. However, its original cut-off score has not been validated in adult asthmatics. The present study aimed to determine the optimal BDI-II cut-off score and to verify the impact of various patient sociodemographic and clinical characteristics on performance accuracy of the BDI-II. Methods: A total of 801 adult asthmatic outpatients (mean ± SD, age 49 ± 14 years, 60% female) completed the BDI-II and a structured psychiatric interview (used as the standard referent to determine presence of major depressive disorder [MDD]). The sensitivity and specificity of the BDI-II were computed to determine the optimal cut-off score for identifying MDD. The optimal cut-off scores were also verified across covariate subgroups (e.g., sex, age, smoking status, asthma control levels). Results: According to the structured psychiatric interview, 108 (13%) patients had current MDD. The overall optimal BDI-II cut-off score was 12 (sensitivity = 85%, specificity = 79%). However, subgroup analyses revealed that this score could range from 11 to 15 depending on the characteristics of the individual. Conclusions: Results suggest that the BDI-II is an appropriate screening tool for MDD in asthma populations. However, the cut-off score is influenced by the sociodemographic and clinical characteristics of patients. These findings highlight the importance of validating generic questionnaires for depression in specific populations in order to improve the accuracy of their usage.

Keywords:

• Depressive symptoms
• diagnostic accuracy
• Beck Depression Inventory II
• sensitivity
• specificity

Acknowledgements

The authors thank Guillaume Lacoste, BA, and Chantal Daigneault for their invaluable assistance with data collection.

Declaration of interest

Dr. Lavoie has served on the advisory board for Schering-Plough, Takeda, AbbVie, Almirall, Janssen, and Boehringer Ingelheim (BI), and received sponsorship for investigator-generated research grants from GlaxoSmithKline (GSK) and AbbVie, lecture fees from GSK, Novartis, Takeda, AbbVie, Merck, AstraZenaca, BI, Pfizer and Air Liquide, and support for educational materials from Merck and Kataka Medical Communication. Dr. Bacon has received consultancy fees from Kataka Medical Communication and Merck for the development of behaviour change continuing education modules and speaker fees from Novartis. Dr. Moullec has received sponsorship for investigator-generated research grant from AstraZeneca. All authors worked on the conception and design of this study. AP and GM performed the literature search. AP and GM did the statistical analysis. All authors were involved in the interpretation and the presentation of data, in the drafting and revision of this manuscript, and approved the final version of the manuscript. KLL and SLB obtained funding for the study.

Funding

Grant support for this study was provided by the Social Sciences and Humanities Research Council of Canada (SSHRC) (KLL) and investigator awards from the Fonds de recherche du Québec – Santé (FRQ-S) (KLL & SLB) and the Canadian Institutes of Health Research (CIHR) (KLL and SLB). AP received scholarship support from the CIHR.