Screening and case finding instruments for depression

Indian Journal of Medical Specialities, 2017

Globally, more than 350 million people of all ages suffer from depression. In spite of the high burden, depression is often unrecognized and undertreated. Inaccurate assessment is one of the important barriers for effective care. Clinical diagnosis is considered as the gold standard for the diagnosis of depression. However, the available instruments help to estimate the burden of depression in epidemiological studies as well as help to screen, diagnose and monitor the treatment in clinical practice. Screening instruments are very useful in community surveys, and can be used for referring patients to psychiatrists. Hence, there is a need to understand the different scales of depression, their advantages, limitations and psychometric properties. This article summarizes various available instruments for assessment of depression and their properties.

The British Journal of Psychiatry, 2007

General Hospital Psychiatry, 2004

Heterogeneity of performance of screening tools in different patient groups has rarely been considered in the literature on depression screening in primary care. The objectives of the present study were to assess and to compare diagnostic accuracy of three screening questionnaires (Brief Patient Health Questionnaire, General Health Questionnaire-12, WHO-5) in identifying depression across various patient subpopulations and to assess the accuracy of the unaided clinical assessment of primary care physicians in the same subgroups. We conducted a cross-sectional validation study in 448 primary care patients. Two-by-two tables as well as receiver operating characteristics were applied. Results indicated that diagnostic accuracy (sensitivity, specificity) of the three screening instruments as well as of the clinical diagnoses differed in the various patient groups. Superiority of one screening tool over the other depends on the subgroup considered. Gender, age, form (subtype), and severity of depression influence the test characteristics of a screening tool. This should be considered if routine depression screening should be widely introduced. Of course, the benefit of routine screening also depends on efforts made for treatment and monitoring of patients in whom depression was diagnosed.

Nordic Journal of Psychiatry, 2010

Lotfi L, Flyckt L, Krakau I, M å rtensson B, Nilsson GH. Undetected depression in primary healthcare: Occurrence, severity and co-morbidity in a two-stage procedure of opportunistic screening. Nord J Psychiatry 2010;Early Online,1-7.

Journal of Psychiatric Practice, 2009

Background-Several studies have contrasted the 16-item self-report version of the Quick Inventory of Depressive Symptomatology (QIDS-SR 16) with other depression scales, but none has used patients in single, large, private psychiatric practice. This study compared 175 outpatients on the QIDS-SR 16 , the 17-item Carroll Depression Rating Scale (CDRS-SR 17 , a self-report modification of the Hamilton Rating Scale for Depression), and the thirteen depression items from the Symptom Check List-90 (SCL-D 13). The Mini version of the Structured Clinical Interview for DSM-IV (MiniSCID) served as a "gold standard" to assess depression. Methods-Basic Item and scale statistics were obtained using classical test theory. Dimensionalities were obtained using factor analysis. Test information functions obtained from the Samejima item response theory model provided additional reliability-like results. This model was also used to compare patients classified as depressed vs. nondepressed on the basis of the MiniSCID. Additional validity information was assessed comparing: (a) ANOVA effect sizes, (b) receiver operating characteristic curves, (c) univariate logistic regression, (d) the MANOVA, and (e) multivariate logistic regression. Results-The QIDS-SR 16 related most strongly to MiniSCID diagnoses. The SCL-D 13 , however, was the most reliable of the three scales (α = .91). It was the most sensitive to differences in depression for all but the most depressed patients, for whom the CDRS-SR 17 was the most sensitive. Conclusions-All three measures performed satisfactorily, but there are clearly defined advantages to using the QIDS-SR 16 , as, by its very design, it assesses the core symptoms of depression and does not require a clinician.

Scandinavian Journal of Primary Health Care, 2011

Objective. Central health organizations suggest routine screening for depression in high-risk categories of primary care patients. This study compares the effectiveness of high-risk screening versus case-fi nding in identifying depression in primary care. Design. Using an observational design, participating GPs included patients from 13 predefi ned risk groups and/or suspected of being depressed. Patients were assessed by the Major Depression Inventory (MDI) and ICD-10 criteria. Setting. Thirty-seven primary care practices in Mainland Denmark. Main outcome measures. Prevalence of depression, diagnostic agreement, effectiveness of screening methods, risk groups requiring special attention. Results. A total of 37 (8.4%) of 440 invited GP practices participated. We found high-risk prevalence of depression in 672 patients for the following traits:

Acta Bio Medica : Atenei Parmensis, 2021

In the last two decades the awareness of depression as a public health issue has increased and the literature has flourished towards its primary and secondary prevention. Whereas timely targeting of depression risk factors is a frontier towards reducing the incidence of the disorder, nowadays the early diagnosis is of primary importance. Screening depressive disorders is paramount, since there are several types of depression. Besides, early diagnosis would improve the outcome of treatment, reduce the frequency of relapses and generally lead to higher levels of quality of life. We highlight the feasibility of depression screening in primary care and the need of a comprehensive public health approach. (www.actabiomedica.it)

Journal of Affective Disorders, 2004

Background: The aim of this study was to compare the validity of the Hospital Anxiety and Depression Scale (HADS), the WHO (five) Well Being Index (WBI-5), the Patient Health Questionnaire (PHQ), and physicians' recognition of depressive disorders, and to recommend specific cut-off points for clinical decision making. Methods: A total of 501 outpatients completed each of the three depression screening questionnaires and received the Structured Clinical Interview for DSM-IV (SCID) as the criterion standard. In addition, treating physicians were asked to give their psychiatric diagnoses. Criterion validity and Receiver Operating Characteristics (ROC) were determined. Areas under the curves (AUCs) were compared statistically. Results: All depression scales showed excellent internal consistencies (Cronbach's a: 0.85 -0.90). For 'major depressive disorder', the operating characteristics of the PHQ were significantly superior to both the HADS and the WBI-5. For 'any depressive disorder', the PHQ showed again the best operating characteristics but the overall difference did not reach statistical significance at the 5% level. Cut-off points that can be recommended for the screening of 'major depressive disorder' had sensitivities of 98% (PHQ), 94% (WBI-5), and 85% (HADS). Corresponding specificities were 80% (PHQ), 78% (WBI-5), and 76% (HADS). In contrast, physicians' recognition of 'major depressive disorder' was poor (sensitivity, 40%; specificity, 87%). Limitations: Our sample may not be representative of medical outpatients, but sensitivity and specificity are independent of disorder prevalence. Conclusions: All three questionnaires performed well in depression screening, but significant differences in criterion validity existed. These results may be helpful in the selection of questionnaires and cut-off points. D

Journal of Clinical Epidemiology, 2005

Objective: Test equivalence of different survey instruments to diagnose depression and to assess its severity. Where equivalence exists, describe how to convert scores between instruments. Study Design: Cross-sectional analysis of six convenience samples consisting of 71 members of a health plan and 107 patients of mental health specialty practices with psychiatric diagnoses were compared using the Beck Depression Inventory (BDI) and one or more of the Primary Care Screener for Affective Disorder, Prime-MD-PHQ, Inventory to Diagnose Depression, the depression subscale of the Psychiatric Diagnostic Screening Questionnaire, and the Mental Health Inventory from the SF-36. Results: Correlations between the screening instruments and the BDI ranged from 0.79 to 0.95 and the sensitivity to depression and the specificity against nondepressive mental health diagnoses was equally good or better. We also describe a method for equating severity scores across instruments and labeling the screener-based severity measures with clinically meaningful descriptions comparable to those used for the BDI. Conclusions: Screener-based severity measures extensively overlap each other. Good screeners for depression can also be good severity instruments. Exploiting screeners as severity instruments can significantly reduce response burden without sacrificing performance. Ć 2005 Elsevier Inc. All rights reserved.

The International Journal of Psychiatry in Medicine, 1998

Objective: It is estimated that 5 percent to 10 percent of primary care patients meet criteria for Major Depressive Disorder with an additional 10 percent to 30 percent experiencing significant subclinical depression. However, only 18 percent to 50 percent of depressed primary care patients are so diagnosed by their primary care physicians and even fewer receive professional mental health care. The current study proposes a quick and efficient means to assist physicians in determining for which patients the resource intensive process of thoroughly screening for depression should be engaged. Method: The present study examined responses of 358 consecutively reporting patients to a midwest university-based primary care clinic on the Beck Depression Inventory. Results: Among individuals reporting high levels of depressive symptomatology, five questions from the Beck Depression Inventory were endorsed by 90 percent or greater of the participants. Analyses by gender indicated that while the same five items were endorsed by males and females, three additional items were frequently endorsed by males. Conclusions: These findings suggest that a means for efficiently identifying individuals who warrant screening for depression may be readily available to primary care physicians. Surprisingly, this screening was found to emphasize psychological rather than vegetative symptoms. Thus, attending to these symptoms and/or complaints *A portion of this article was presented at the A M M~ Meeting of the Association for the Advancement of Behavior Therapy, 1994.