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Screening for depression in primary care: will one or two items suffice?
Verena Henkel1, Roland Mergl, James C Coyne
1Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336 Munich, Germany. verena.henkel@psy.med.uni-muenchen.de
European Archives of Psychiatry and Clinical Neuroscience
|August 17, 2004
Summary
Screening for depression can be simplified to just two questions, reducing patient and clinician burden. This two-question approach maintains effectiveness comparable to longer screening tools for depressive disorders.
Area of Science:
- Psychiatry
- Primary Care Medicine
- Psychometrics
Background:
- Screening for mental health conditions in primary care is crucial for timely intervention.
- The implementation and burden of existing screening tools can impact sustainability in routine practice.
- Optimizing screening instruments is necessary to balance diagnostic accuracy with clinical feasibility.
Purpose of the Study:
- To evaluate the psychometric properties of single and two-item versions of the WHO-5 Well-Being Index for depression screening.
- To compare the performance of abbreviated screening tools against the original WHO-5 and other established screeners.
- To assess the feasibility of reducing screening burden without compromising diagnostic accuracy.
Main Methods:
- Analysis of screening and diagnostic interview data from 431 primary care patients.
- Assessment of sensitivity, specificity, and Area Under the Curve (AUC) values for various screening item combinations.
- Utilized the Composite International Diagnostic Interview (CIDI) as the criterion standard for diagnosis.
Main Results:
- Single-item screening questions demonstrated inadequate performance for depression detection.
- Two-item combinations showed marginal differences in performance compared to longer instruments for major depression, dysthymia, and any depressive disorder.
- No statistically significant differences were observed in AUC values or most other test characteristics between two-item and longer screeners.
Conclusions:
- Depression screening in primary care can potentially be reduced to two questions.
- A two-question screener offers advantages in ease of administration, scoring, and reduced patient/staff burden.
- Simplified screening may also mitigate stigma associated with positive mental health assessments.