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Screening for depression in primary care: Will one or two items suffice?

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Abstract.

Small differences in implementation of screening and the associated burden on clinicians and patients could have substantial effects on the sustainability of screening in routine primary care. Therefore, we investigated the psychometric properties of single items and two–item combinations of the “WHO-5 Well Being Index” (WHO-5) and compared the obtained characteristics to those of the original version as well as to another proposed two–item screener (developed from PRIME–MD and BPHQ, respectively).

Screening and diagnostic interview data from 431 primary care patients were analysed. Main outcome measures were sensitivity, specificity and AUC values. All test characteristics were assessed using the diagnoses derived from the Composite International Diagnostic Interview (CIDI) as the criterion standard.

Single–item screening questions proved rather inadequate. However, only marginal differences in performance were found between two questions and the longer screening instrument with respect to major depression, dysthymia and “any depressive disorder”. There were no statistically significant differences between these AUC values and most other test characteristics assessed.

The results suggest that screening could be reduced to two questions with a potential advantage in terms of ease of administration and scoring and decreased staff and patient burden and perhaps a reduced stigma associated with a positive screening score.

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Authors and Affiliations

  1. Department of Psychiatry, Ludwig-Maximilians-University, Nußbaumstr. 7, 80336, Munich, Germany

    Verena Henkel M. D., R. Mergl M.Sc., H.-J. Möller Prof., M. D. & U. Hegerl Prof.,M. D.

  2. Department of Psychiatry, University of Pennsylvania Health System, 11 Gates, 3400 Spruce St, PA-19104 Philadelphia, USA

    J. C. Coyne Ph. D.

  3. Institute for Medical Research Management and Biometrics, (IMEREM), Scheurlstr. 21, 90478, Nuremberg, Germany

    R. Kohnen Ph. D.

Authors
  1. Verena Henkel M. D.
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  2. R. Mergl M.Sc.
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  3. J. C. Coyne Ph. D.
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  4. R. Kohnen Ph. D.
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  5. H.-J. Möller Prof., M. D.
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  6. U. Hegerl Prof.,M. D.
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Correspondence to Verena Henkel M. D..

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Henkel, V., Mergl, R., Coyne, J.C. et al. Screening for depression in primary care: Will one or two items suffice?. European Archives of Psychiatry and Clinical Neurosciences 254, 215–223 (2004). https://doi.org/10.1007/s00406-004-0476-3

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  • DOI: https://doi.org/10.1007/s00406-004-0476-3

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