Eliana Brehaut's ARIA project:Â Optimal cutoff selection in depression screening studies using the PHQ-9, EPDS, and HADS
I completed my ARIA internship under the supervision of Dr. Brett Thombs and the DEPRESsion Screening Data (DEPRESSD) team. My project was a systematic review of the methods of optimal cutoff selection in 100 depression screening studies that used the Patient Health Questionnaire-9 (PHQ-9). In mental health screening, cutoff thresholds are chosen to identify individuals who may be at risk for disorder and determine whether further investigation is required. When selecting optimal cutoffs, researchers should consider factors such as invasiveness and costs of further diagnostic tests and the likely benefits versus harms of correctly identifying or missing cases. This information, however, is often unavailable, and many different methods are used to select and recommend cutoff thresholds. My review aimed to (1) determine the proportion of depression screening studies that identified one or more ‘optimal’ cutoffs based on study results; (2) for studies that identified at least one optimal cutoff, determine whether methods for cutoff selection were described, and if so, what methods were used; and (3) determine the proportion of studies that reported an optimal cutoff that provided a rationale for choosing certain methods, and describe what those rationales were. We also compared identified optimal cutoffs to the PHQ-9 standard screening cutoff of ≥ 10, and to the cutoff with the highest Youden’s J index. If identified cutoffs differed from the standard, we described author recommendations for which cutoffs to use in practice.
I was interested in completing an ARIA project because I viewed it as an opportunity to complete further research in my area of choice. I did my honours thesis with Dr. Thombs and his team, which investigated depression prevalence estimates based on a widely used screening tool versus a validated diagnostic interview. After being exposed to the multitude of unanswered questions on the topic of depression screening, I thought that a second project would allow me to further my knowledge in this fascinating clinical research area.
My objectives for this internship were to expand my knowledge of scientific research methods, learn more about the work of other students in the Faculty of Arts, particularly outside of the Psychology Department, and provide/share tips for remote research.
One highlight of my internship was learning about various software that could be useful for student research through the ARIA Library Research Workshops. These videos introduced me to Altmetric, which ended up being extremely helpful to me as a way of demonstrating how much scientific and media attention certain studies received. Another highlight was the Poster Workshop. Since the Psychology Department’s Undergraduate Research Day was cancelled this year, I did not have the opportunity to present a poster for my honours thesis and was unfamiliar with the poster-making process. I thought that the online workshop provided useful tips on how to make clear, concise, and effective posters - a skill that will be useful not only in my undergraduate education, but in future academic endeavours as well.
The biggest challenge that I faced throughout my internship was making the transition from in-person to remote research. While I am lucky in that my project was a systematic review and relatively easy to complete online, I found it difficult to replace face-to-face supervision meetings with emails and Zoom calls. Further, being stuck at home with family members who all needed to use the internet at the same time often resulted in connectivity issues, making communication more difficult. Online supervision meetings became easier with time, and my connectivity issues were largely mitigated by working out a ‘meeting schedule’ with my family. While this meant having to stay off of the internet during certain hours of the week, it ensured that no more than three of us would be using the internet for video calling at once. This made online communication go much more smoothly for all of us.
ARIA has given me the opportunity for further exposure to scientific research in the area of Clinical Psychology. The knowledge I have developed throughout this internship will certainly help prepare me for graduate studies and will hopefully be a useful starting point for a career in a related field. I believe that the remote aspect of this internship has pushed me to become more independent in terms of my research abilities and required me to assert myself more in reaching out to my supervisor and mentors for help.
I would like to thank all those who contributed to the Arts Student Employment Fund Award, as well as the Thombs DEPRESSD team, for making my summer internship project possible.
