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Related Experiment Videos

Case-finding for depression in primary care: a randomized trial.

J W Williams1, C D Mulrow, K Kroenke

  • 1San Antonio Veterans Health Services Research Field Program, and Division of General Internal Medicine, University of Texas Health Science Center, USA.

The American Journal of Medicine
|May 13, 1999
PubMed
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A single question about depression is as effective as a longer screening tool and more practical for primary care. While case-finding improves recognition, it does not consistently enhance patient outcomes.

Area of Science:

  • Primary Care Medicine
  • Psychiatry
  • Clinical Epidemiology

Background:

  • Depression is a common, serious, and costly illness often missed in primary care.
  • Effective screening tools are needed to improve depression recognition and treatment.

Purpose of the Study:

  • To evaluate the accuracy and primary care impact of two depression case-finding instruments against usual care.
  • To compare a single-question screen with the 20-item Center for Epidemiologic Studies Depression Screen (CES-D).

Main Methods:

  • Randomized trial in four clinics comparing a single question, the 20-item CES-D, and usual care.
  • Patients were assessed for Diagnostic and Statistical Manual of Mental Disorders Third Revised Edition (DSM-III-R) depression by a blinded interviewer.
  • Outcomes included diagnostic accuracy, recognition rates, treatment, and symptom recovery at 3 months.

Related Experiment Videos

Main Results:

  • The 20-item CES-D was more specific (75% vs. 66%) but less feasible than the single question.
  • Both instruments modestly increased depression recognition (39% vs. 29%) but did not improve treatment rates.
  • Recovery from depression was higher in case-finding groups (48% vs. 27%), but mean symptom improvement did not differ significantly.

Conclusions:

  • A single depression question is a feasible and accurate alternative to longer screening tools in primary care.
  • While case-finding improves depression recognition, its impact on treatment and overall patient outcomes requires further investigation.