Screening for depression in primary care

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 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

Medical Journal of Australia, 2002

There is insufficient evidence for routine screening for depression in asymptomatic patients. 1 IN AUSTRALIA, more than 800 000 adults 2 and 95 000 children and adolescents 3 experience depressive disorders each year, and depression is a leading cause of both ongoing disability and premature mortality. 4 Furthermore, depression is seen to make substantial contributions to major medical and behavioural disorders, such as heart disease and alcohol or other substance misuse. Much effort is currently directed towards increasing community awareness of depression 5 and improving the quality of medical interventions provided. 6 Importantly, in the absence of broad population and enhanced health service approaches, the contribution of depression to overall disability and premature mortality is projected to increase and be second only to cardiovascular disease by 2020. 7 Data from Australian general practice 8,9 show that most patients with depression or anxiety presenting to medical care do not receive a psychological diagnosis or appropriate interventions. Consequently, some mental health advocates promote the use of simple case-detection systems on both clinical and epidemiological grounds. 10-12 The more conservative position has been to reject such calls, arguing conceptual, practical and ethical limitations. 1 As the number of relevant studies has increased, it is timely to review this evidence. We sought to answer the following questions: ■ Can screening tools efficiently and accurately identify patients with depression? ■ Do clinicians use the information obtained from screening tools to assist with diagnosis and treatment planning? ■ Is the outcome of patients with depression improved within practice settings that use screening tools (alone or in combination with other techniques)? and ■ Is there evidence that the benefit is limited to specific subpopulations of patients? Methods Methods have been developed to conduct systematic evaluations of reviews. 13,14 These methods are efficient and reliable, and avoid the need to consult the original articles (unless considerable disagreement exists between the conclusions of well-conducted reviews). We used these methods, focusing our attention on systematic reviews of "casefinding" and "screening/intervention" procedures for common forms of depression encountered in primary care, general practice or other related general medical settings.

The Cochrane library, 2005

Analysis 1.2. Comparison 1 Recognition of depression following feedback, Outcome 2 Recognition of depression following feedback [unselected patients].

Background Unidentified depression in primary care is a public health concern, globally. There is a need for brief, valid and easily administered tools in primary care. Aims To estimate reliability and validity of the newly developed Primary care Screening Questionnaire for Depression (PSQ4D), a four-item tool, with 'yes' or 'no' options. Method PSQ4D was administered verbally (time required, <1 min) by primary care physicians to adult outpatients (n=827) in six primary care settings in Kerala, India. A psychiatrist evaluated each patient on the same day, using ICD-10 Diagnostic Criteria for Research, based on unstructured clinical interview. Results The Cronbach's alpha for internal consistency reliability was 0.80; kappa coefficient for test-retest reliability was 0.9 and that for interrater reliability was 0.72. At a score ≥2, sensitivity was 0.96, specificity was 0.87, positive predictive value was 0.74, negative predictive value was 0.98, positive likelihood ratio was 7.4 and negative likelihood ratio was 0.05. Conclusions When physician administered, PSQ4D has good reliability. At a cutoff score of ≥2, it has high sensitivity and specificity to identify depressive disorder in primary care.

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).

Psychological Assessment, 2010

The present study examined the utility of the anhedonic depression scale from the Mood and Anxiety Symptoms Questionnaire (MASQ-AD) as a way to screen for depressive disorders. Using receiver-operator characteristic analysis, the sensitivity and specificity of the full 22-item MASQ-AD scale, as well as the 8 and 14-item subscales, were examined in relation to both current and lifetime DSM-IV depressive disorder diagnoses in two nonpatient samples. As a means of comparison, the sensitivity and specificity of a measure of a relevant personality dimension, neuroticism, was also examined. Results from both samples support the clinical utility of the MASQ-AD scale as a means of screening for depressive disorders. Findings were strongest for the MASQ-AD 8-item subscale and when predicting current depression status. Furthermore, the MASQ-AD 8-item subscale outperformed the neuroticism measure under certain conditions. The overall usefulness of the MASQ-AD scale as a screening device is discussed, as well as possible cutoff scores for use in research.

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 …, 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%