BMJ  2003;327:1144-1146 (15 November), doi:10.1136/bmj.327.7424.1144

Primary care

Screening for depression in primary care with two verbally asked questions: cross sectional study

¹ Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, PB 92019, Auckland, New Zealand, ² Department of Psychiatry, University of Auckland

Objective To determine the diagnostic accuracy of two verbally asked questions for screening for depression.

Design Cross sectional criterion standard validation study.

Setting 15 general practices in New Zealand.

Participants 421 consecutive patients not taking psychotropic drugs.

Main outcome measures Sensitivity, specificity, and likelihood ratios of the two questions compared with the computerised composite international diagnostic interview.

Results The two screening questions showed a sensitivity and specificity of 97% (95% confidence interval, 83% to 99%) and 67% (62% to 72%), respectively. The likelihood ratio for a positive test was 2.9 (2.5 to 3.4) and the likelihood ratio for a negative test was 0.05 (0.01 to 0.35). Overall, 37% (157/421) of the patients screened positive for depression.

Conclusion Two verbally asked questions for screening for depression would detect most cases of depression in general practice. The questions have the advantage of brevity. As treatment is more likely when doctors make the diagnosis, these questions may have even greater utility.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Effect of the addition of a "help" question to two screening questions on specificity for diagnosis of depression in general practice: diagnostic validity study

B Arroll, F Goodyear-Smith, N Kerse, T Fishman, and J Gunn
BMJ 2005 331: 884. [Abstract] [Full Text] [PDF]

Two questions can help detect depression
BMJ 2003 327: 0. [Full Text]

Dawn of the diagnostic age

Kamran Abbasi
BMJ 2003 327: 0. [Extract] [Full Text] [PDF]

How many conditions can a GP screen for?

Chris Del Mar and Paul Glasziou
BMJ 2003 327: 1117. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Bennett, I. M., Coco, A., Coyne, J. C., Mitchell, A. J., Nicholson, J., Johnson, E., Horst, M., Ratcliffe, S. (2008). Efficiency of a Two-Item Pre-Screen to Reduce the Burden of Depression Screening in Pregnancy and Postpartum: An IMPLICIT Network Study. J Am Board Fam Med 21: 317-325 [Abstract] [Full text]  
• Anderson, I., Ferrier, I., Baldwin, R., Cowen, P., Howard, L, Lewis, G, Matthews, K, McAllister-Williams, R., Peveler, R., Scott, J, Tylee, A (2008). Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2000 British Association for Psychopharmacology guidelines. J Psychopharmacol 22: 343-396 [Abstract]  
• Mitchell, A. J. (2007). Pooled Results From 38 Analyses of the Accuracy of Distress Thermometer and Other Ultra-Short Methods of Detecting Cancer-Related Mood Disorders. JCO 25: 4670-4681 [Abstract] [Full text]  
• Bayliss, E. A., Ellis, J. L., Steiner, J. F. (2007). Barriers to Self-Management and Quality-of-Life Outcomes in Seniors With Multimorbidities. Ann Fam Med 5: 395-402 [Abstract] [Full text]  
• WEICH, S., NAZARETH, I., MORGAN, L., KING, M. (2007). Treatment of depression in primary care: Socio-economic status, clinical need and receipt of treatment. Br. J. Psychiatry 191: 164-169 [Abstract] [Full text]  
• Dubowitz, H., Feigelman, S., Lane, W., Prescott, L., Blackman, K., Grube, L., Meyer, W., Tracy, J. K. (2007). Screening for Depression in an Urban Pediatric Primary Care Clinic. Pediatrics 119: 435-443 [Abstract] [Full text]  
• Tonnesen, P., Carrozzi, L., Fagerstrom, K. O., Gratziou, C., Jimenez-Ruiz, C., Nardini, S., Viegi, G., Lazzaro, C., Campell, I. A., Dagli, E., West, R. (2007). Smoking cessation in patients with respiratory diseases: a high priority, integral component of therapy. Eur Respir J 29: 390-417 [Abstract] [Full text]  
• Oopik, P., Aluoja, A., Kalda, R., Maaroos, H.-I. (2006). Screening for depression in primary care. Fam Pract 23: 693-698 [Full text]  
• Lowe, B. (2006). Adding a question that asks whether help is wanted improves sensitivity of a depression screening tool.. Evid. Based Ment. Health 9: 39-39 [Full text]  
• The MaGPle Research Group, including, , Bushnell, J., McLeod, D., Dowell, A., Salmond, C., Ramage, S., Collings, S., Ellis, P., Kljakovic, M., McBain, L. (2005). Do patients want to disclose psychological problems to GPs?. Fam Pract 22: 631-637 [Abstract] [Full text]  
• Arroll, B, Goodyear-Smith, F, Kerse, N, Fishman, T, Gunn, J (2005). Effect of the addition of a "help" question to two screening questions on specificity for diagnosis of depression in general practice: diagnostic validity study. BMJ 331: 884- [Abstract] [Full text]  
• Robinson, J. A, Crawford, G. B (2005). Identifying palliative care patients with symptoms of depression: an algorithm. Palliat Med 19: 278-287 [Abstract]  
• Seehusen, D. A., Baldwin, L.-M., Runkle, G. P., Clark, G. (2005). Are Family Physicians Appropriately Screening for Postpartum Depression?. J Am Board Fam Med 18: 104-112 [Abstract] [Full text]  
• (2004). Easy Way to Screen for Depression in Primary Care. JWatch Gastroenterology 2004: 7-7 [Full text]  
• (2004). Easy Way to Screen for Depression in Primary Care. JWatch Psychiatry 2004: 11-11 [Full text]  
• (2004). Easy Way to Screen for Depression in Primary Care. JWatch General 2004: 2-2 [Full text]  
• Del Mar, C., Glasziou, P. (2003). How many conditions can a GP screen for?. BMJ 327: 1117-1117 [Full text]  

Rapid Responses:

Read all Rapid Responses

Two Questions Does Not Work Accurately

Alex J Mitchell
bmj.com, 14 Nov 2003 [Full text]

WHERE DOES OUR REMIT END?

mackenzie graeme
bmj.com, 14 Nov 2003 [Full text]

screening for depression or dumbing down?

J Martin Dace
bmj.com, 15 Nov 2003 [Full text]

It's just not that simple!

James C D McMillan
bmj.com, 16 Nov 2003 [Full text]

Two or five verbally asked screening questions for depression?

Kaj Sparle Christensen
bmj.com, 17 Nov 2003 [Full text]

Re: Two Questions Does Not Work Accurately

Adam Burrows
bmj.com, 17 Nov 2003 [Full text]

Depression by GPs: another point of view

Alfonso SAURO
bmj.com, 18 Nov 2003 [Full text]

We need realistic information on the time involved in screening

Christopher G Timmis
bmj.com, 19 Nov 2003 [Full text]

Authors' reply

Bruce Arroll, et al.
bmj.com, 25 Nov 2003 [Full text]

Screening can lead to the medicalisation of distress

Richard Byng
bmj.com, 4 Dec 2003 [Full text]

Poor subjective well-being is a health hazard

Heli-Tuulie J Koivumaa-Honkanen
bmj.com, 17 Dec 2003 [Full text]

Computing specificity

Jan MA Mens
bmj.com, 25 Apr 2004 [Full text]