D2 | Abstract 17

Annual NUTRIM Symposium 18 November 2020

APPLIED SCIENCE

Examining the optimal cut-off values of the most commonly used screening instruments for depression and anxiety in IBS

J.T.W. Snijkers1,2, W. van den Oever1,2, Z.Z.R.M. Weerts1,2, L. Vork1,2, Z. Mujagic1,2, C. Leue3,4, M.A.M. Hesselink1,2, J.W. Kruimel1,2, J.W.M. Muris5, R.M.M. Bogie1,6, A.A.M. Masclee1,2, D.M.A.E. Jonkers1,2 and D. Keszthelyi1,2

1 Division of Gastroenterology-Hepatology, Department of Internal Medicine, MUMC+, Maastricht, the Netherlands.
2 NUTRIM, Maastricht University, Maastricht, the Netherlands.
3 Department of Psychiatry and Psychology, MUMC+, Maastricht, the Netherlands.
4 MHeNS, Maastricht University, Maastricht, the Netherlands.
5 Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands.
6 GROW, Maastricht University, Maastricht, the Netherlands.
Introduction:
 Self-rating scales are frequently used to screen for anxiety and depression in patients with Irritable Bowel Syndrome (IBS). Different cut-off values are recommended in literature and guidelines have suggested the use of other screening instruments over time.

Objective:
 The aim of this study was to assess the correlation between the most commonly used psychological screening instruments for anxiety and depression in IBS and to compare custom cut-off scores for these instruments.

Methods:
 IBS patients (n=192) completed several questionnaires including the Hospital Anxiety and Depression Scale (HADS, HADS-A and HADS-D subscale), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). Agreement at different cut-off points, for depressive and anxiety disorder, was assessed by use of the Gwet AC1 coefficient.

Results:
 HADS-D and PHQ-9 scores, and HADS-A and GAD-7 scores showed high correlations (rs= 0.735 and rs=0.805, respectively). For depressive disorder, a Gwet AC1 value of 0.829 was found when recommended cut-off points from literature were compared (PHQ-9 cut-off ≥10, HADS-D cut-off ≥8). For anxiety disorder, a Gwet AC1 value of 0.806 was found when recommended cut-off points from literature were compared (GAD-7 cut-off ≥10, HADS-A cut-off ≥8). Even higher agreements were found when higher HADS cut-off values were chosen, with impact on sensitivity and specificity.

Conclusions:
 Custom cut-off values deem the HADS subscales (HADS-D and HADS-A) concordant to PHQ-9 and GAD-7 scores. The choice of a cut-off value has substantial impact on sensitivity/specificity and is dependent on patient population, setting, and the purpose of use.
OVERVIEW D2 ABSTRACTS OVERVIEW APPLIED SCIENCE

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