Screening tools for psychiatric disorders in multiple sclerosis – Systematic review and metanalysis

ABSTRACT

Objective

To conduct a systematic review with meta-analysis aimed to highlight the most appropriate psychiatric screening tools for clinical approach of multiple sclerosis adult patients evaluated by diagnostic accuracy studies.

Methods

Medline, SciELO, PubMed e Lilacs databases were searched using the terms “multiple sclerosis psychiatric symptoms” and “multiple sclerosis psychiatric screening” for articles related to the proposed theme. Articles in Portuguese and English language published between 2007 and 2017 were included. The quality of included studies was assessed using the QUADAS method. A meta-analysis was conducted using RevMan 5.3.

Results

Seven papers were selected for analysis. The reviewers’ rating were in agreement with a 0.95 kappa. Most of the selected studies performed screening tools for depression, with only two of them addressing the search for anxiety disorders. Screening for depressive disorder was performed by the evaluation of 11 different instruments, while anxiety by only two. Most of the tests presented good accuracy – the BAI tool was the only one with a regular performance in the ROC analysis (0.77 AUC). The other tests presented with good or excellent performance, presenting more than 83% in the evaluation of AUC.

Conclusions

The HADS (Hospital Anxiety and Depression Scale), CESD (Center for Epidemiological Scale – Depression) and PHQ-9 (Patient Health Questionnaire-9) tools seem to be the most suitable for the psychiatric screening of patients with multiple sclerosis. PROSPERO registration: CRD42017082741.

Multiple sclerosis; depression; anxiety disorders