Validity of the medical outcomes study depression screener in family practice training centers and community settings

Screening inventories that identify primary care patients suffering from depression should be brief, correlate with depression diagnoses, and be evaluated in populations with whom the inventories will be used.

A total of 566 patients from a medical school training center and 457 patients from six community family practice offices completed the Medical Outcomes Study (MOS) depression screener and a questionnaire reporting demographic information and health habits. All subjects scoring above the recommended screener cut-off, and a random sample of those scoring below, were interviewed with the Diagnostic Interview Schedule (DIS).

A total of 195 subjects from the training center and 147 from the community sample were called and administered the DIS. About 33% of the training center and 25% of the community sample scored above the cutoff. Of those above the cutoff and administered the DIS, 23% of the training center and 10% of the community sample were diagnosed with either major depression or dysthymia.

The MOS screener was an effective method of identifying depressed subjects in the training center and community settings. However, because of the relatively low prevalence of depression in these settings, a relatively high number are falsely screened positive. Identifying these patients as having subthreshold depressive symptoms and the necessity/efficacy of treatment is controversial, as is the use of screening instruments. The simplified MOS scoring strategy and template used in this study would probably increase its usefulness in the primary care setting.