Intended for healthcare professionals

Primary Care

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 2005; 331 doi: (Published 13 October 2005) Cite this as: BMJ 2005;331:884
  1. B Arroll, professor (b.arroll{at},
  2. F Goodyear Smith, senior lecturer1,
  3. N Kerse, associate professor1,
  4. T Fishman, senior lecturer2,
  5. J Gunn, associate professor
  1. 1Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Private Bag 92019, Auckland, New Zealand
  2. 2Department of General Practice University of Melbourne, Australia
  1. Correspondence to: B Arroll
  • Accepted 23 August 2005


Objective To determine the validity of two written screening questions for depression with the addition of a question inquiring if help is needed.

DesignCross sectional validation study.

Setting 19 general practitioners in six clinics in New Zealand.

Participants 1025 consecutive patients receiving no psychotropic drugs.

Main outcome measures Sensitivity, specificity, and likelihood ratios of the two screening questions, the help question, combinations of the screening and help questions, and diagnosis by general practitioners.

Results The help question alone had a sensitivity of 75% (95% confidence interval 60% to 85%) and a specificity of 94% (93% to 96%). The positive likelihood ratio for the help question was 13.0 (9.5 to 17.8) and the negative likelihood ratio was 0.27 (0.17 to 0.44). The likelihood ratio for patients wanting help today was 17.5 (11.8 to 31.9). The general practitioner diagnosis had a sensitivity of 79% (65% to 88%) and a specificity of 94% (92% to 95%).

Conclusion Adding a question inquiring if help is needed to the two screening questions for depression improves the specificity of a general practitioner diagnosis of depression.


  • Contributors BA, FG-S, NK, TF, and JG were involved in the design, interpretation of data, and drafting of the paper. BA analysed the data. He is guarantor.

  • Funding Oakley Mental Health Foundation.

  • Competing interests None declared.

  • Ethical approval Auckland ethics committee.

  • Accepted 23 August 2005
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