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Centre for Evidence-
Based Medicine

Depression - 2 questions can rule out the diagnosis

Clinical Bottom Line

Negative responses to the 2-question case-finding instrument can rule out depression.

Citation

Whooley MA, Avins, AL, Miranda J, Browner WS. Case-finding instruments for depression: Two questions are as good as many. J Gen Intern Med 1997;12:439-45.

Clinical Question

In patients with suspected depression what is the accuracy of a 2-question case-finding instrument for depression compared with 6 previously validated instruments?

Search Terms

"depression" or "depressive disorder" and "sensitivity and specificity" and "questionnaire" and "primary care" or "primary health care" in MEDLINE.

The Study

590 consecutive patients (mean age 53 years, 97% men) who visited an urgent-care clinic at a Veterans Affairs Hospital in the United States were given a self-report questionnaire that included the 2-question instrument taken from the Primary Care Evaluation of Mental Disorders Procedure: "During the past month, have you often been bothered by feeling down, depressed, or hopeless?" and " During the past month, have you often been bothered by little interest or pleasure in doing things?" The patients also completed 6 other validated instruments for detecting depression. The diagnostic standard was the National Institute of Mental Health Diagnostic Interview Schedule that was administered by trained psychology students who were blinded to the results of the case-finding instruments. Prevalence of depression in this sample was 18%, which is higher than other primary care settings.

The Evidence

Target Disorder
Depression
Totals
Present Absent
Diagnostic
Test Result
2-question instrument
Positive

93

a

189

b

282

a + b

Negative

4

c

250

d

254

c + d

Totals

a + c

97

b + d

439

a + b + c + d

536

Sensitivity = a/(a+c)
= 93/97
= 96%

Specificity = d/(b+d)
= 250/439
= 57%

Likelihood Ratio for a positive test result (LR+) = sens/(1-spec)
= 0.96/1-0.57
= 2.2

Likelihood Ratio for a negative test result (LR-) = (1-sens)/spec
= 1-0.96/0.57
= 0.07

Comments

Sample was not representative of most primary health care agencies (predominantly unemployed men with a high prevalence of depression). Would want to test the instrument on a more representative sample.

Appraised By

Donna Ciliska RN, PhD.
Associate Professor, School of Nursing
McMaster University, Hamilton, Ontario, Canada.
Fax: (905) 546-0401
Email: ciliska@fhs.mcmaster.ca
Appraised February 1999.

Expiry Date

2000