title: Improved detection of depression in primary care through severity evaluation.
abstract: OBJECTIVE
  To determine whether the use of a symptom severity measure to augment an existing Diagnostic and Statistical Manual of Mental Disorders-Third Edition, Revised (DSM-III-R) criteria-based depression screener (PRIME-MD) would decrease the difficulties associated with depression screening in primary care by filtering out patients with minimal impairment.
  
  
  METHODS
  The study design was secondary data analysis.
  
  
  METHODS
  The study sample comprised 1317 patients, with intentional oversampling by ethnicity and sex, presenting for routine care at a university family practice center in Galveston, Texas.
  
  
  METHODS
  The primary outcomes were cross-sectional, health-related quality-of-life outcomes of subjects who met symptom severity criteria as well as criteria for a DSM-III-R mood disorder. Health care utilization outcomes were examined as secondary outcomes.
  
  
  RESULTS
  The combination of a 6-item depression severity instrument and the PRIME-MD resulted in 71% of depressed subjects being categorized as severely symptomatic and 29% as minimally symptomatic. Severely symptomatic subjects had significantly worse SF-36 Mental Health Component Summary scale (MCS) scores than did minimally symptomatic subjects (32.8 vs 43.5, P <.05). Minimally symptomatic subjects had MCS scores similar to those of a third group of subjects who did not meet DSM-III-R "threshold" criteria for mood disorder but who were severely symptomatic. Adjusted health care utilization was higher for the initial 3-month charge period in the severely symptomatic depressed subjects compared with minimally symptomatic depressed subjects ($679.20 vs $462.38, P <.05).
  
  
  CONCLUSIONS
  The 6-item depression severity measure effectively separated patients meeting DSM-III-R "threshold" depression criteria into 2 groups: one presenting with severe symptoms and impairment and the other presenting with mild symptoms and significantly less impairment. A strategy of initial screening using a brief depression severity instrument, followed with a DSM criteria-based instrument, could decrease the immediate clinician workload by one third and focus treatment on those most likely to benefit.
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor, USA.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Nease
authors.forename: Michael S
authors.initials: MS
authors.lastname: Klinkman
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Volk
mesh_terms: D000328:Adult; D003863:Depression / Q000145:classification / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care; D012720:Severity of Illness Index