Heidi M Munger Clary1, Mingyu Wan2, Kelly Conner3, Gretchen A Brenes4, James Kimball5, Esther Kim6, Pamela Duncan7, Beverly M Snively8. 1. Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: hmungerc@wakehealth.edu. 2. Wake Forest University, Neuroscience Graduate Program, USA. Electronic address: MingyuWan2021@u.northwestern.edu. 3. Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: kconner@wakehealth.edu. 4. Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: gbrenes@wakehealth.edu. 5. Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: jkimball@wakehealth.edu. 6. Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: EKKim@mednet.ucla.edu. 7. Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: pduncan@wakehealth.edu. 8. Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: bmellen@wakehealth.edu.
Abstract
OBJECTIVE: Recent epilepsy quality measure recommendations for depression and anxiety screening endorse ultra-brief screeners, the Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2). Thus, it is important to assess how symptom detection may be affected using ultra-brief screeners compared with slightly longer, well-validated instruments: Neurological Disorders Depression Inventory-Epilepsy (NDDI-E) and Generalized Anxiety Disorder-7 (GAD-7). The objective was to compare symptom detection by brief versus ultra-brief depression and anxiety screeners in a large real-world epilepsy clinic sample. METHODS: This was a prospective, cross-sectional assessment of consecutive patients in an adult tertiary epilepsy practice who completed the GAD-7 and NDDI-E with embedded ultra-brief scales (GAD-2; GAD-Single Item: GAD-SI; NDDI-E 2 item: NDDIE-2) on a tablet and had clinic staff administered ultra-brief PHQ-2 (yes/no version) documented in the medical record at the same visit. Prevalences of positive anxiety and depression screens were calculated for each instrument overall, and by epilepsy status. Concordance correlation coefficients (CCC) were calculated comparing the ultra-brief with brief anxiety and depression instruments, and receiver operating curves (ROC) were calculated using the longer instruments as alternative standards. RESULTS: Among N = 422 individuals the prevalence of positive anxiety screen by GAD-7 was 24% and positive depression screen by NDDI-E was 20%. Positive anxiety and depression screens were significantly less prevalent among seizure-free individuals than those with continued seizures. The verbally administered yes/no PHQ-2 had only 1 positive screen (0.2%). Other than poor concordance between the PHQ-2 and NDDI-E, the screener pairs had acceptable concordance (CCC 0.79 to 0.92). Areas under the ROC curves were acceptable for the NDDIE-2, GAD-2 and GAD-SI (0.96, 0.98, and 0.89, respectively). SIGNIFICANCE: In this sample, clinic staff interview-administered yes/no PHQ-2 had exceedingly low sensitivity compared with the NDDI-E self-reported on a tablet. Further investigation is warranted to assess if poor detection is due to characteristics of this PHQ-2 in epilepsy samples, or method of administration in this clinic. The other ultra-brief anxiety and depression instruments demonstrated good concordance with the longer, well-validated instruments and may be useful in clinical practice.
OBJECTIVE: Recent epilepsy quality measure recommendations for depression and anxiety screening endorse ultra-brief screeners, the Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2). Thus, it is important to assess how symptom detection may be affected using ultra-brief screeners compared with slightly longer, well-validated instruments: Neurological Disorders Depression Inventory-Epilepsy (NDDI-E) and Generalized Anxiety Disorder-7 (GAD-7). The objective was to compare symptom detection by brief versus ultra-brief depression and anxiety screeners in a large real-world epilepsy clinic sample. METHODS: This was a prospective, cross-sectional assessment of consecutive patients in an adult tertiary epilepsy practice who completed the GAD-7 and NDDI-E with embedded ultra-brief scales (GAD-2; GAD-Single Item: GAD-SI; NDDI-E 2 item: NDDIE-2) on a tablet and had clinic staff administered ultra-brief PHQ-2 (yes/no version) documented in the medical record at the same visit. Prevalences of positive anxiety and depression screens were calculated for each instrument overall, and by epilepsy status. Concordance correlation coefficients (CCC) were calculated comparing the ultra-brief with brief anxiety and depression instruments, and receiver operating curves (ROC) were calculated using the longer instruments as alternative standards. RESULTS: Among N = 422 individuals the prevalence of positive anxiety screen by GAD-7 was 24% and positive depression screen by NDDI-E was 20%. Positive anxiety and depression screens were significantly less prevalent among seizure-free individuals than those with continued seizures. The verbally administered yes/no PHQ-2 had only 1 positive screen (0.2%). Other than poor concordance between the PHQ-2 and NDDI-E, the screener pairs had acceptable concordance (CCC 0.79 to 0.92). Areas under the ROC curves were acceptable for the NDDIE-2, GAD-2 and GAD-SI (0.96, 0.98, and 0.89, respectively). SIGNIFICANCE: In this sample, clinic staff interview-administered yes/no PHQ-2 had exceedingly low sensitivity compared with the NDDI-E self-reported on a tablet. Further investigation is warranted to assess if poor detection is due to characteristics of this PHQ-2 in epilepsy samples, or method of administration in this clinic. The other ultra-brief anxiety and depression instruments demonstrated good concordance with the longer, well-validated instruments and may be useful in clinical practice.
Authors: Frank G Gilliam; John J Barry; Bruce P Hermann; Kimford J Meador; Victoria Vahle; Andres M Kanner Journal: Lancet Neurol Date: 2006-05 Impact factor: 44.182
Authors: Heidi M Munger Clary; Rachel D Croxton; Jonathan Allan; James Lovato; Gretchen Brenes; Beverly M Snively; Mingyu Wan; James Kimball; Matthew H Wong; Cormac A O'Donovan; Kelly Conner; Victor Jones; Pamela Duncan Journal: Epilepsy Behav Date: 2020-01-27 Impact factor: 2.937
Authors: Ingrid E Scheffer; Samuel Berkovic; Giuseppe Capovilla; Mary B Connolly; Jacqueline French; Laura Guilhoto; Edouard Hirsch; Satish Jain; Gary W Mathern; Solomon L Moshé; Douglas R Nordli; Emilio Perucca; Torbjörn Tomson; Samuel Wiebe; Yue-Hua Zhang; Sameer M Zuberi Journal: Epilepsia Date: 2017-03-08 Impact factor: 5.864
Authors: S Petrovski; C E I Szoeke; N C Jones; M R Salzberg; L J Sheffield; R M Huggins; T J O'Brien Journal: Neurology Date: 2010-09-14 Impact factor: 9.910
Authors: Albert L Siu; Kirsten Bibbins-Domingo; David C Grossman; Linda Ciofu Baumann; Karina W Davidson; Mark Ebell; Francisco A R García; Matthew Gillman; Jessica Herzstein; Alex R Kemper; Alex H Krist; Ann E Kurth; Douglas K Owens; William R Phillips; Maureen G Phipps; Michael P Pignone Journal: JAMA Date: 2016-01-26 Impact factor: 56.272
Authors: Anup D Patel; Christine Baca; Gary Franklin; Susan T Herman; Inna Hughes; Lisa Meunier; Lidia M V R Moura; Heidi Munger Clary; Brandy Parker-McFadden; Mary Jo Pugh; Rebecca J Schultz; Marianna V Spanaki; Amy Bennett; S Andrew Josephson Journal: Neurology Date: 2018-10-03 Impact factor: 9.910