A systematic review of instruments to measure depressive symptoms in patients with schizophrenia

Background: Depressive symptoms require accurate recognition and monitoring in clinical practice of patients with schizophrenia.Depression instruments developed for use in depressed patients may not discriminate depressive symptoms from negative psychotic symptoms.Objective: We reviewed depression instruments on their reliability and validity in patients with schizophrenia.Methodology: A systematic literature search was carried out in three electronic databases.Psychometric properties were extracted for those instruments of which reliability, divergent, concurrent and predictive validity were reported in one or more publications.Results: Forty-eight publications described the reliability and validity of six depression instruments in patients with schizophrenia.The only self-report was the Beck Depression Inventory (BDI).The Brief Psychiatric Rating Scale-Depression subscale (BPRS-D), Positive and Negative Syndrome Scale-Depression subscale (PANSS-D), Hamilton Rating Scale for Depression (HAMD), Montgomery Asberg Depression Rating Scale (MADRS) and Calgary Depression Scale for Schizophrenia (CDSS) were clinician rated.All instruments were reliable for the measurement of depressive symptoms in patients with schizophrenia.The CDSS most accurately differentiated depressive symptoms from other symptoms of schizophrenia (divergent validity), correlated well with other depression instruments (concurrent validity), and was least likely to miss cases of depression or misdiagnose depression (predictive validity).Conclusions: We would recommend to use the CDSS for the measurement of depressive symptoms in research and in daily clinical practice of patients with schizophrenia.A valid selfreport instrument is to be developed for the use in clinical practice.