Identifying patients with depression in the primary care setting: a more efficient method.
OBJECTIVE
To determine if there is a core subset of depressive symptoms that could be used to efficiently diagnose depression after administering the 2-item PRIME-MD a screening questionnaire for depression.


METHODS
One thousand patients selected randomly and by convenience from 4 primary care clinics were assessed by PRIME-MD and completed a questionnaire measuring the following validation variables: functional status and well-being, disability days, somatic symptoms, depression severity, suicidal thoughts, health care utilization, and the physician-patient relationship.


RESULTS
Four symptoms (sleep disturbance, anhedonia, low self-esteem, and decreased appetite) accounted for virtually all the depression symptom-related variance in functional status and well-being, with 8.3% of patients having 2 of these symptoms and 8.2% having 3 or 4 of these symptoms. There was excellent agreement between diagnosis based on core symptoms and major depression (K= 0.77; overall accuracy rate, 94%). There were significant differences (P<.001) among patients with negative depression screen, 0 to 1, 2, and 3 to 4 core symptoms with scores on each of the validation variables getting progressively worse in these 4 groups. A cutoff point of 2 core symptoms identified all but 3 patients with major depression and an additional 5% of the entire sample without major depression who were significantly (P<.05) worse than patients without depression on each of the validation variables.


CONCLUSIONS
A strategy that includes the use of a 2-item depression screener followed by the evaluation of 4 core depressive symptoms is an efficient and effective way of identifying and classifying primary care patients with depression in need of clinical attention.
Brody
D S
DS
Allegheny University of the Health Sciences, Philadelphia, Pa 19102-1192, USA.
Hahn
S R
SR
Spitzer
R L
RL
Kroenke
K
K
Linzer
M
M
deGruy
F V
FV
Williams
J B
JB
D000407:Alabama; D001066:Appetite; D001900:Boston; D003863:Depression / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D003866:Depressive Disorder / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D003937:Diagnosis, Differential; D006801:Humans; D008396:Maryland; D019964:Mood Disorders / Q000209:etiology; D009519:New York City; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012649:Self Concept; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000209:etiology; D011795:Surveys and Questionnaires