ABSTRACT
BACKGROUND: Depressive symptoms among patients with amyotrophic lateral sclerosis (ALS) are usually measured with conventional questionnaires. These measurements do not consider the specific circumstances of the underlying disease. The purpose of this study was to assess the validity of a new short 12 items ALS-Depression-Inventory (ADI-12). We determined convergent, criterion, and concurrent validity. The Structured Clinical Interview (SCID) for DSM-IV was used as the gold standard and the Beck Depression Inventory (BDI) and the WHO Well Being Index (WHO-5) to assess concurrent validity. METHODS: A total of 39 ALS patients in all stages of the disease were interviewed. Convergent validity was estimated by the inter-correlation between the ADI-12 and the BDI. Criterion and concurrent validity were specified with respect to sensitivity, specificity and predictive values. Receiver Operating Characteristics (ROC) and Areas Under the Curves (AUC) were calculated. RESULTS: All three depression scales showed excellent internal consistencies (Cronbach's alpha: .8-.9). The correlation between the ADI-12 and the BDI was high (r=.80). For the ADI-12 a cut-off of > or = 30 (SE=100%, SP=83%) identified all patients with a current episode of major depression. A more liberal cut-off (> or = 23) identified all patients with any depressive disorder including minor depression at the cost of specificity (60%). CONCLUSIONS: With the ADI-12 ALS patients with depressive disorders can be reliably identified. We recommend the ADI-12 for routine screening in primary care of ALS patients.
Subject(s)
Amyotrophic Lateral Sclerosis/psychology , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/etiology , Surveys and Questionnaires , Adult , Aged , Depressive Disorder, Major/epidemiology , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Male , Mass Screening/methods , Middle Aged , Reproducibility of Results , World Health OrganizationABSTRACT
INTRODUCTION: There is increasing debate on the issue of whether to facilitate the end-of-life decisions of severely disabled patients with diseases such as amyotrophic lateral sclerosis (ALS). Our two studies were intended to explore the emotional state and quality of life of patients with ALS. METHODS: Two studies were performed to investigate depression and the quality of life in ALS patients: one was a longitudinal study, the other a comparison of ALS patients to normal control subjects. RESULTS: These studies found no correlation between physical disability in ALS and either depression or the quality of life. The severity of depression was found to be inversely related to educational status. In ALS patients the quality of life was comparable with healthy controls. DISCUSSION: The rationale for not providing life-sustaining treatment to severely disabled patients is that a poor quality of life is expected after such treatment. Our studies have shown, however, that ALS patients can experience a satisfactory quality of life without depressive manifestations even if they are severely physically impaired, including in the terminal phase.