Clinical utility of the Montgomery-Åsberg Depression Rating Scale for the detection of depression among bariatric surgery candidates

Abstract

BackgroundClinical assessment of depression is an important part of pre-surgical assessment among individuals with morbid obesity. However, there is no agreed-upon instrument to identify mood psychopathology in this population. We examined the reliability and criterion validity of the clinician-administered Montgomery-Åsberg Depression Rating Scale (MADRS) and the utility of a short version for bariatric surgery candidates.MethodsThe sample was 374 patients with obesity, consecutively recruited from the waiting list of a bariatric surgery clinic of University Hospital, Brazil: women 80 %, mean BMI 47 kg/m2, mean age 43.0 years. The 10-item MADRS was analyzed against the SCID-I. Items that showed small relevance to sample’s characteristics and contribution to data variability were removed to develop the short 5-item version of scale. We calculated the sensitivity and specificity of cutoff points of both versions MADRS, and values were plotted as a receiver operating characteristic curve.ResultsFor the 10-item MADRS, the Cronbach’s alpha coefficient was 0.93. When compared against SCID-I, the best cut-off threshold was 13/14, yielding sensitivity of 0.81 and specificity 0.85. Following items were removed: reduced appetite, reduced sleep, concentration difficulties, suicide thought and lassitude. The 5-item version showed an alpha coefficient of 0.94 and a best cut-off threshold of 10/11, yielding sensitivity of 0.81 and specificity 0.87. Similar overall ability to discriminate depression of almost 90 % was found for both 10-item and 5-item MADRS.ConclusionThe MADRS is a reliable and valid instrument to assess depressive symptoms among treatment-seeking bariatric patients. Systematic application of the abbreviated version of the MADRS can be recommended for enhancing the clinical detection of depression during perioperative period.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0823-8) contains supplementary material, which is available to authorized users.

The Validity of the Montgomery-Asberg Depression Rating Scale in an Inpatient Sample with Alcohol Dependence

“…The optimal cut-point identified by the Euclidean distance was 14; however, as this cut-point had a relatively low sensitivity and specificity, we are unable to endorse the use of a cut-point for identifying potential depression using the MADRS. This finding may be due to AD and depression both being mental health conditions rather than one being a physical condition, as was the case with the previous studies (Leentjens et al, 2000, Rhondali et al, 2015, Duarte-Guerra et al, 2016). Distinguishing between the two conditions may be more difficult among our study sample due the possibility of alcohol-induced depressive symptoms.…”

“…This has previously been demonstrated in other populations where somatic overlap of symptoms occurs, e.g. bariatric surgery patients (Duarte-Guerra et al, 2016), patients with Parkinson’s disease (Leentjens et al, 2000) and geriatric populations with ovarian cancer (Rhondali et al, 2015). These studies found the MADRS to have a high sensitivity and specificity compared to a clinical diagnosis of a depressive disorder.…”

“…The MADRS has shown good discriminate properties between those with and without a DSM diagnosis of depression among other clinical settings. Duarte-Guerra and colleagues found a 13/14 cut score on the MADRS demonstrated a sensitivity of 85% and specificity of 81% among bariatric surgery patients (Duarte-Guerra et al, 2016). Similarly, Leentjens et al found a 14/15 cut score among patients with Parkinson’s Disease had a sensitivity of 88% and a specificity of 89% (Leentjens et al, 2000), and Rhondali et al found a cut score of 16 to have a 88% sensitivity and 91% specificity in elderly patients with ovarian cancer (Rhondali et al, 2015).…”

“…This study has one of the largest sample sizes used to evaluate MADRS in a targeted sample (Leentjens et al, 2000, Duarte-Guerra et al, 2016, Rhondali et al, 2015). The inpatient setting allowed for a careful monitoring of alcohol abstinence and withdrawal.…”

Perfil psicopatológico de pacientes com obesidade candidatos à cirurgia bariátrica: análise de classes latentes e fatores associados

“…Frequently, mood symptoms decrease after bariatric surgery, due to patient's satisfaction with self-image and improvement of quality of life associated with %EWL (De Zwaan, 2012). Depressive symptoms have been investigated among patients seeking the bariatric procedure through assessment scales (Duarte-Guerra et al, 2016;Schutt et al, 2016). Further emergence of post-operative manic/hypomanic symptoms are described in several studies Ahmed et al, 2013;Godini et al, 2016), as well as their frequent co-occurrence with additional psychiatric conditions (Da Silva et al, 2015).…”