The psychometric properties of depression screening tools in primary healthcare settings: A systematic review

J Affect Disord. 2018 Jan 1:225:503-522. doi: 10.1016/j.jad.2017.08.060. Epub 2017 Aug 23.


Background: Consensus on a tool for depression screening among adults in primary healthcare (PHC) settings is lacking. This systematic review aimed to explore the psychometric properties of depression screening tools.

Methods: A systematic literature search composed of four terms (screening AND psychometric AND depression AND primary healthcare) was conducted in PubMed, EMBASE, PsycINFO and MEDLINE, between January 1995 through October 2015. Studies that aimed to psychometrically test a depression screening tool among the general adult population in a PHC setting were included. Studies exploring the diagnostic properties of depression screening tools among specific populations were excluded.

Results: Sixty publications, evaluating the psychometric properties of 55 tools or adaptations, were included. Studies were conducted in 24 countries and 18 languages on 48234 adults. The Patient Health Questionnaire-9 was the most evaluated tool with 14 studies evaluating its psychometric properties. Fifty-four studies reported on at least one measure of receiver operating characteristics. Sensitivity and specificity values ranged from 28% to 100% and 43% to 100%, respectively. Cronbach alpha values ranged from 0.56 to 0.94. Other forms of reliability and validity testing were less consistently and commonly reported.

Limitations: The inclusion of studies regardless of methodological quality or design may have limited generalizability, but allowed for a comprehensive and detailed overview of the current literature.

Conclusions: Depression screening tools vary in their psychometric properties. The PHQ-9 was the most extensively psychometrically tested tool. This systematic review may aid PHC professionals in choosing a depression screening tool for universal use as it provides a comprehensive overview of their psychometric properties.

Keywords: Depression; Primary healthcare; Psychometric; Screening.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Depression / diagnosis*
  • Depressive Disorder / diagnosis*
  • Female
  • Humans
  • Male
  • Mental Health / statistics & numerical data*
  • Patient Health Questionnaire / standards*
  • Primary Health Care / statistics & numerical data*
  • Psychometrics
  • Reproducibility of Results