Screening for depression and suicidality in a VA primary care setting: 2 items are better than 1 item

Am J Manag Care. 2004 Nov;10(11 Pt 2):839-45.


Objective: To evaluate the psychometric properties of a single-item depression screen against validated scoring algorithms for the Patient Health Questionnaire (PHQ) and the utility of these algorithms in screening for depression and suicidality in a Department of Veterans Affairs (VA) primary care setting.

Study design: Recruitment phase of a randomized trial.

Methods: A total of 1211 Portland VA patients with upcoming primary care clinic appointments were administered by telephone a single item assessing depressed mood over the past year and the PHQ. The PHQ-9 (9 items) encompasses DSM-IV criteria for major depression, the PHQ-8 (8 items) excludes the thoughts of death or suicide item, and the PHQ-2 (2 items) assesses depressed mood and anhedonia. Patients whose responses suggested potential suicidality were administered 2 additional items assessing suicidal ideation. Patients receiving mental health specialty care were excluded.

Results: Using the PHQ-9 algorithm for major depression as the reference standard, the VA single-item screen was specific (88%) but less sensitive (78%). A PHQ-2 score of > or =3 demonstrated similar specificity (91%) with high sensitivity (97%). For case finding, the PHQ-8 was similar to the PHQ-9. Approximately 20% of patients screened positive for moderate depression, 7% reported thoughts of death or suicide, 2% reported thoughts of harming themselves, and 1% had specific plans.

Conclusions: The PHQ-2 offers brevity and better psychometric properties for depression screening than the single-item screen. The PHQ-9 item assessing thoughts of death or suicide does not improve depression case finding; however, one third of patients endorsing this item reported recent active suicidal ideation.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Validation Study

MeSH terms

  • Aged
  • Algorithms
  • Community Health Centers / organization & administration*
  • Community Health Centers / statistics & numerical data
  • Depressive Disorder / classification
  • Depressive Disorder / diagnosis*
  • Female
  • Humans
  • Male
  • Mass Screening / methods*
  • Middle Aged
  • Oregon
  • Outpatient Clinics, Hospital / organization & administration*
  • Outpatient Clinics, Hospital / statistics & numerical data
  • Patient Selection
  • Primary Health Care / methods*
  • Primary Health Care / statistics & numerical data
  • Psychiatric Status Rating Scales
  • Psychometrics / instrumentation*
  • Self-Assessment*
  • Suicide / psychology*
  • Surveys and Questionnaires*
  • Telephone
  • United States
  • United States Department of Veterans Affairs
  • Veterans / psychology*