Meta-analysis of screening and case finding tools for depression in cancer: Evidence based recommendations for clinical practice on behalf of the Depression in Cancer Care consensus group
Meta-analysis of screening and case finding tools for depression in cancer: Evidence based recommendations for clinical practice on behalf of the Depression in Cancer Care consensus group
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DOI：
10.1016/j.jad.2011.12.043
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发表时间：
2012-10-01
影响因子：
6.6
通讯作者：
Zabora, James
中科院分区：
文献类型：
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作者：
Mitchell, Alex J.;Meader, Nick;Zabora, James
背景：检验ICD10/DSM-IV标准定义的筛查和病例发现工具在抑郁症识别中的有效性。方法：我们确定了63项研究，涉及19种工具(33篇出版物)，旨在帮助临床医生识别癌症背景下的抑郁症。我们使用了标准化的评级系统。我们排除了11个没有至少两项独立研究的工具，留下了8个工具进行比较。结果：在所有癌症分期中，共有56项诊断有效性研究(n=10.009)。在病例发现方面，1个干题、2个干题和BDI-11都有2级证据(分别为2a、2b和2c)，鉴于它们较好的可接受性，我们给了干题B级推荐。对于筛选，两个STEM问题具有1b级证据(可接受性较高)，BDI-II具有2c级证据。对于每100名接受晚期癌症筛查的人，这两个问题将准确检测出18个病例，而只漏掉1个，并正确地安抚74个被错误识别的7个病例。对于每100名在非姑息状态下进行筛查的人，BDI-11将准确检测出17例病例，遗漏2例，并正确地保证70例，其中11例被错误识别为病例。主要的警告是依赖于DSM-IV对抑郁症的定义，大量的小型研究，以及在特定环境下许多工具的数据匮乏。结论：虽然没有一个工具可以提供完全合格的支持，但有几个工具可能会在没有辅助的临床识别的基础上得到改进。在临床实践中，所有工具都应该成为综合方法的一部分，包括进一步的随访、临床评估和循证治疗。(C)2012爱思唯尔B.V.保留所有权利。
Background: To examine the validity of screening and case-finding tools used in the identification of depression as defined by an ICD10/DSM-IV criterion standard.Methods: We identified 63 studies involving 19 tools (in 33 publications) designed to help clinicians identify depression in cancer settings. We used a standardized rating system. We excluded 11 tools without at least two independent studies, leaving 8 tools for comparison. Results: Across all cancer stages there were 56 diagnostic validity studies (n = 10.009). For case-finding, one stem question, two stem questions and the BDI-11 all had level 2 evidence (2a, 2b and 2c respectively) and given their better acceptability we gave the stem questions a grade B recommendation. For screening, two stem questions had level 1b evidence (with high acceptability) and the BDI-II had level 2c evidence. For every 100 people screened in advanced cancer, the two questions would accurately detect 18 cases, while missing only 1 and correctly reassure 74 with 7 falsely identified. For every 100 people screened in non-palliative settings the BDI-11 would accurately detect 17 cases, missing 2 and correctly re-assure 70, with 11 falsely identified as cases. The main cautions are the reliance on DSM-IV definitions of major depression, the large number of small studies and the paucity of data for many tools in specific settings.Conclusions: Although no single tool could be offered unqualified support, several tools are likely to improve upon unassisted clinical recognition. In clinical practice, all tools should form part of an integrated approach involving further follow-up, clinical assessment and evidence based therapy. (C) 2012 Elsevier B.V. All rights reserved.