A 44-year-old woman on dialysis thrice weekly reports profound fatigue, anhedonia, insomnia, and poor appetite. Her nephrologist suspects major depressive disorder. Which rating scale is validated for assessing depression specifically in renal failure patients?

• A Hamilton Depression Rating Scale (HAM-D)
• B Beck Depression Inventory for Renal Insufficiency (BDI-RI) ✓
• C Beck Depression Inventory (BDI)
• D Edinburgh Postnatal Depression Scale (EPDS)

Explanation

Standard depression rating scales such as the BDI include somatic items (fatigue, anorexia, sleep disturbance) that are commonly caused by uraemia rather than depression per se, leading to false elevation of scores. The Beck Depression Inventory for Renal Insufficiency (BDI-RI) is a modified version validated in dialysis patients, excluding somatic items that overlap with uraemic symptoms. HAM-D and BDI are still used but overestimate depression prevalence in this population. EPDS is validated for perinatal depression.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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