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Identifying patients with depression in the primary care setting: a more efficient method

D S Brody1, S R Hahn, R L Spitzer

  • 1Allegheny University of the Health Sciences, Philadelphia, Pa 19102-1192, USA.

Archives of Internal Medicine
|December 17, 1998
PubMed
Summary
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A brief depression screening using the 2-item PRIME-MD, followed by assessing four core symptoms, efficiently identifies primary care patients with depression. This method accurately diagnoses major depression and flags those needing clinical attention.

Area of Science:

  • Primary Care Medicine
  • Psychiatry
  • Clinical Psychology

Background:

  • Depression diagnosis in primary care is challenging.
  • Efficient screening tools are needed to identify patients requiring clinical attention.
  • The PRIME-MD is a validated depression screening questionnaire.

Purpose of the Study:

  • To identify a core subset of depressive symptoms for efficient depression diagnosis.
  • To evaluate the effectiveness of a 2-item PRIME-MD screener combined with core symptom assessment.

Main Methods:

  • 1000 primary care patients were assessed using the PRIME-MD.
  • Patients completed questionnaires on functional status, well-being, disability, somatic symptoms, depression severity, suicidal thoughts, healthcare utilization, and physician-patient relationship.

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  • Validation variables were analyzed in relation to depression symptoms.

    • Main Results:

    • Four core symptoms (sleep disturbance, anhedonia, low self-esteem, decreased appetite) explained most depression-related variance in functional status and well-being.
    • A diagnosis based on these core symptoms showed excellent agreement with major depression (K=0.77, 94% accuracy).
    • A cutoff of 2 core symptoms identified nearly all major depression cases while also identifying patients without depression who had worse outcomes.

    Conclusions:

    • A strategy using a 2-item depression screener followed by evaluation of 4 core symptoms is efficient and effective for identifying primary care patients with depression.
    • This approach aids in classifying patients who need clinical attention.
    • The identified core symptoms provide a focused diagnostic approach in primary care settings.