Discussion
The purpose of the present investigation was to determine whether screening measures designed for the general population, the medically ill, or PWE are superior for use in detecting depression in PWE. It has previously been suggested that common self-report depression screening measures, particularly those more heavily weighted with neurovegetative symptoms of depression such as the BDI-II, may result in inaccurate reports of depression, particularly a high false positive rate and subsequent inflated prevalence rates. Conversely, those designed specifically for the medically ill, which remove confounding neurovegetative items, may miss important depression-related symptoms such as seen in ‘masked depression.’ Thus, the new measure developed within, which excludes items only based on patient report was hypothesized to yield better specificity and overall accuracy at differentiating depressed versus non-depressed PWE as compared to existing measures.
As expected, the proposed EPI-BDI-M was found to obtain greater specificity (85%) than previously proposed cutoffs of the BDI-II and CES-D (70 and 77%, respectively). It also obtained a higher specificity than the previous cutoff of 4 on the BDI-PC. The prevalence rate derived from this measure was also most akin to the rate derived from a clinical interview, suggesting some merit to utilizing follow-up questions on a self-report measure; similar to what is done through a clinical interview. However, while the measure demonstrated an improved specificity, it came at a sacrifice to its sensitivity, which is not seen with a raised cutoff of 6 on the BDI-PC, which has superb specificity and good sensitivity. Findings of the EPI-BDI in this sample suggests that there is need for improvement with this measure if it is to be utilized with PWE.
