A single question to screen for major depression in the general population

Major depression is frequent but underrecognized. Our objective was to investigate the usefulness of a single question as a clinical indicator for current major depressive disorder in the general population.

Data were drawn from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). The NESARC is a survey of 43,093 adults aged 18years and older residing in households in the United States. Odds ratios (OR), 95% confidence intervals (CIs), and test characteristics (sensitivity, specificity, positive and negative predictive values and positive likelihood ratio) of the question "During the past 4weeks, how often did you felt downhearted and depressed?" for the detection of current DSM-IV major depressive disorder were determined.

Participants who reported having felt downhearted and depressed "a little of the time," "some of the time," "most of the time" or "all the time" were more likely than participants reporting those feeling "none of the time" during the last 4weeks to be diagnosed with current major depressive disorder (OR 4.15 [95% CI, 3.57-4.83]; OR, 9.23 [95% CI, 7.93-10.74]; OR, 23.97 [95% CI, 20.21-28.44]; and OR, 24.00 [95% CI, 19.08-30.18], respectively). The likelihood ratio for a positive test ranged between 6.49 (5.89-7.14) and 8.07 (7.18-9.07), going from a 7.1% pretest probability of major depression up to 31.9% if the participant report having felt downhearted and depressed "most of the time" or "all the time" during the past 4weeks.

The single screening question has potential for use in primary care settings.