Screening for anxiety and depression in primary care with the Duke Anxiety-Depression Scale.
OBJECTIVE
Anxiety and depression are highly prevalent and underdiagnosed in primary care. This study tested the seven-item Duke Anxiety-Depression Scale (DUKE-AD) in primary care adult patients as a screener for anxiety and depression as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R).


METHODS
Receiver operating characteristic curves (ROC) and odds ratios were used to test screener accuracy, and sensitivities and specificities were used to test screener efficiency in patients with anxiety and/ or depression.


RESULTS
In 481 patients, the ROC area for patients with major anxiety disorders (panic disorder, agoraphobia, or generalized anxiety) was 72.3%. The ROC area for major depressive disorders (major depressive disorder and/or dysthymia) was 78.3%, and the ROC area for both major anxiety and/or depressive disorders was 76.2%. Odds ratios for these same groups after controlling for sociodemographic factors were 1.043, 1.057, and 1.053, respectively. Sensitivities and specificities for these groups at the DUKE-AD score cutoff point of > 30 on a 0-100 scale were 71.4% and 59.2%, 81.8% and 63.6%, and 73.9% and 66.1%, respectively.


CONCLUSIONS
The DUKE-AD is a brief, easily scored questionnaire that serves as a valid screener for DSM-III-R anxiety and depression in the primary care setting.
Parkerson
G R
GR
Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA. parke001@me.duke.edu
Broadhead
W E
WE
D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D016017:Odds Ratio; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012372:ROC Curve; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires