Two-question depression-screeners – the solution to all problems?

BMJ, 2003

BMJ, 2003

Objective To determine the diagnostic accuracy of two verbally asked questions for screening for depression. Design Cross sectional criterion standard validation study. Setting 15 general practices in New Zealand. Participants 421 consecutive patients not taking psychotropic drugs. Main outcome measures Sensitivity, specificity, and likelihood ratios of the two questions compared with the computerised composite international diagnostic interview. Results The two screening questions showed a sensitivity and specificity of 97% (95% confidence interval, 83% to 99%) and 67% (62% to 72%), respectively. The likelihood ratio for a positive test was 2.9 (2.5 to 3.4) and the likelihood ratio for a negative test was 0.05 (0.01 to 0.35). Overall, 37% (157/421) of the patients screened positive for depression. Conclusion Two verbally asked questions for screening for depression would detect most cases of depression in general practice. The questions have the advantage of brevity. As treatment is more likely when doctors make the diagnosis, these questions may have even greater utility.

Journal of …, 2010

Objective: The purpose of this study is to compare the diagnostic accuracy of four depression screening tools commonly used in patients with medical disorders, relative to a reference diagnostic standard-a structured psychiatric interview. Methods: The Depression in the Medically Ill-18 (DMI-18) questionnaire was administered to 167 patients with medical disorders; of those, 53 completed the Beck Depression Inventory for Primary Care (BDI-PC), 67 the Hospital Anxiety and Depression Scale (HADS), and 46 the Patient Health Questionnaire-9 (PHQ-9). The entire sample was also interviewed with a structured psychiatric interview conducted by a mental health professional. Sensitivity, specificity, likelihood ratios (LRs), and area under the curve (AUC) were calculated and compared for the different measures. Results: At their respective recommended cutoff points, sensitivities [95% confidence interval (CI)] were 86% (70-95), 82%

Primary Care and Community Psychiatry, 2005

All rights reserved: reproduction in whole or part not permitted Background: A high number of patients in primary care suffer from depressive disorders. General practitioners (GPs) have an important function in detecting depression at an early stage. There is evidence that the detection of depressive disorders can be optimised by implementing routine screening. Aim: To analyse the acceptability of the PHQ-D as screening tool for depressive disorders in primary care. Design/Setting: Feasibility study in general practices in South Baden (Germany) Methods: 1034 patients of 17 GPs in single practices were screened with the Patient Health Questionnaire and asked to evaluate the screening tool in terms of its acceptability for routine practice. The GPs assessed the complaints and diagnoses of each patient and also evaluated the screening tool in terms of its practicability for daily care. Results: GPs and patients evaluate the screening questionnaire differently, with patients rating the usefulness of the instrument more positively. 50.0% of the GPs rated it as an impediment, whereas 75.8% of the patients evaluated it as feasible for routine. No differences were found between patients with and without depressive symptoms. Conclusion: Patients accept the PHQ-D for assessing depressive symptoms in primary care. The GPs' belief that patients would not accept such questionnaires proved not to be in accordance with the patients' evaluation. More detailed analyses are needed to evaluate the efficiency of the PHQ-D for routine care.

Journal of Affective Disorders, 2014

Background: The Beck Depression Inventory Fast Screen (BDI-FS) is a self-report instrument for the detection of depression in youths and adults. It measures the severity of the depression, corresponding to the non-somatic criteria for the diagnosis of a major depression according to DSM-5. Until now the psychometric properties of the instrument have not been studied in the general population. Methods: In 2012, a survey representative for the Federal Republic of Germany was conducted. In addition to the BDI-FS, further self-rating questionnaires as well as a demographic questionnaire were administered. Results: Altogether, 4480 people were surveyed with a return rate of 56.1% (N¼ 2467 persons). Approximately 53% of those surveyed were women. The average age was 49.4 years (SD¼ 18.0), with a range of 14-91 years. For the BDI-FS total-scores, a coefficient α of .84 was determined (women: α¼.83; men: α¼.85). In addition, a convergent validity (r ¼ .67) was determined with the Patient Health Questionnaire (PHQ-9). The discriminant validity of the BDI-FS can be classified as satisfactory. Based on a confirmatory factor analysis, the one-dimensionality of the BDI-FS could be confirmed, achieving very good fit indices (total sample: RMSEA ¼.058, CFI ¼.990, TLI¼ .986). An additional invariance analysis regarding gender, different age groups and their interaction resulted in strict invariance for the different multi-group analyses. Limitations: Studies regarding stability have yet to be undertaken. A standard diagnostic interview for depression was not included. Conclusion: The results support the reliability and validity of the BDI-FS for use with the general German population. Although in the present studies the BDI-FS was superior to the PHQ-9 in terms of its ability to discriminate between depressive and somatic symptoms, in future investigations the diagnostic efficiency of the BDI-FS should be compared with this and other depression inventories (e.g., PHQ-2, PHQ-8, and CES-D).

The availability of brief screening instruments encourages their routine use in identifying individuals who are presumed to be at risk for clinical depression. In primary medical care where this idea has been most tested, however, there is little evidence that screening by itself improves the outcome of depression. Reasons why screening cannot serve as an efficient basis for the prevention of depression are reviewed. Moreover, a positive score on a screening instrument does not indicate a clear need for intervention or the form that any intervention should take. Routine screening should be undertaken only when the resources are available for interpreting the significance of positive screen scores, appropriate and acceptable interventions are available, and potential negative effects of screening can be avoided. Until these conditions can be met, alternatives to screening should be considered.

International Journal of Environmental Research and Public Health

Introduction: Though self-reported items (SRD, self-reported depression) are commonly used in health surveys and cohort studies, their metric properties as a depression indicator remain unclear. The aims were to evaluate the measurement properties of SRD using the Patient Health Questionnaire-8 (PHQ-8) as reference and to identify factors related to the agreement between both indicators. Methods: Data from the European Health Interview Survey in Spain in 2014/2015 (n = 22,065) were analyzed. Two indicators of depression were considered: SRD based on two items yes/no (positive: both yes), and the PHQ-8 (positive ≥ 10). Socioeconomic factors and use of health services were considered as independent variables. The prevalence of depression, sensitivity, specificity, global agreement, and positive and negative predictive values (PPV and NPV) of SRDs were evaluated using the PHQ-8 as a reference. Logistic regression models were fitted to determine factors associated with the agreement bet...

European Archives of Psychiatry and Clinical Neurosciences, 2004

■ Abstract Small differences in implementation of screening and the associated burden on clinicians and patients could have substantial effects on the sustainability of screening in routine primary care. Therefore, we investigated the psychometric properties of single items and two-item combinations of the "WHO-5 Well Being Index" (WHO-5) and compared the obtained characteristics to those of the original version as well as to another proposed two-item screener (developed from PRIME-MD and BPHQ, respectively).

GSTF Journal of Psychology (JPsych), 2014

The purpose of this study was to assess the convergent validity of a single depression question with multiple classification options for depression screening. Participants were 40 medical inpatients. The age range of our sample was 18 to 85 years (M = 56.15, SD = 17.66). A clinical interview and the BDI-II were administered. The correlation between patients' self-rating classification of depression and their BDI-II classification was significant, r s (38) = .90, p < .01. Follow-up repeated-measures chisquare revealed a statistically significant association between BDI-II classification and patients' self-rating classification, χ 2 (9, N = 40) = 47.79, p < .005. Significant positive standardized residuals revealed a clear linear relationship between BDI-II and patient self-rating classifications. Our data support the use of a single depression question with multiple classification options as a useful and valid means of quickly screening for the presence of depression by frontline health care professionals.

BMC Medical Research Methodology, 2011

Background: Screening instruments for mental disorders need to be short, engaging, and valid. Current screening instruments are usually questionnaire-based and may be opaque to the user. A prototype approach where individuals identify with a description of an individual with typical symptoms of depression, anxiety, social phobia or panic may be a shorter, faster and more acceptable method for screening. The aim of the study was to evaluate the accuracy of four new prototype screeners for predicting depression and anxiety disorders and to compare their performance with existing scales. Methods: Short and ultra-short prototypes were developed for Major Depressive Disorder (MDD), Generalised Anxiety Disorder (GAD), Panic Disorder (PD) and Social Phobia (SP). Prototypes were compared to typical short and ultra-short self-report screening scales, such as the Centre for Epidemiology Scale, CES-D and the GAD-7, and their short forms. The Mini International Neuropsychiatric Interview (MINI) version 6 [1] was used as the gold standard for obtaining clinical criteria through a telephone interview. From a population sample, 225 individuals who endorsed a prototype and 101 who did not were administered the MINI. Receiver operating characteristic (ROC) curves were plotted for the short and ultra short prototypes and for the short and ultra short screening scales. Results: The study found that the rates of endorsement of the prototypes were commensurate with prevalence estimates. The short-form and ultra short scales outperformed the short and ultra short prototypes for every disorder except GAD, where the GAD prototype outperformed the GAD 7. Conclusions: The findings suggest that people may be able to self-identify generalised anxiety more accurately than depression based on a description of a prototypical case. However, levels of identification were lower than expected. Considerable benefits from this method of screening may ensue if our prototypes can be improved for Major Depressive Disorder, Social Phobia and Panic Disorder.