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

Arch Intern Med. 1998 Dec 7-21;158(22):2469-75. doi: 10.1001/archinte.158.22.2469.

Abstract

Objective: To determine if there is a core subset of depressive symptoms that could be used to efficiently diagnose depression after administering the 2-item PRIME-MD a screening questionnaire for depression.

Methods: One thousand patients selected randomly and by convenience from 4 primary care clinics were assessed by PRIME-MD and completed a questionnaire measuring the following validation variables: functional status and well-being, disability days, somatic symptoms, depression severity, suicidal thoughts, health care utilization, and the physician-patient relationship.

Results: Four symptoms (sleep disturbance, anhedonia, low self-esteem, and decreased appetite) accounted for virtually all the depression symptom-related variance in functional status and well-being, with 8.3% of patients having 2 of these symptoms and 8.2% having 3 or 4 of these symptoms. There was excellent agreement between diagnosis based on core symptoms and major depression (K= 0.77; overall accuracy rate, 94%). There were significant differences (P<.001) among patients with negative depression screen, 0 to 1, 2, and 3 to 4 core symptoms with scores on each of the validation variables getting progressively worse in these 4 groups. A cutoff point of 2 core symptoms identified all but 3 patients with major depression and an additional 5% of the entire sample without major depression who were significantly (P<.05) worse than patients without depression on each of the validation variables.

Conclusion: A strategy that includes the use of a 2-item depression screener followed by the evaluation of 4 core depressive symptoms is an efficient and effective way of identifying and classifying primary care patients with depression in need of clinical attention.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Alabama
  • Appetite
  • Boston
  • Depression / complications
  • Depression / diagnosis*
  • Depression / psychology
  • Depressive Disorder / complications
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / psychology
  • Diagnosis, Differential
  • Humans
  • Maryland
  • Mood Disorders / etiology
  • New York City
  • Primary Health Care
  • Psychiatric Status Rating Scales
  • Regression Analysis
  • Self Concept
  • Severity of Illness Index
  • Sleep Wake Disorders / etiology
  • Surveys and Questionnaires