Screening for depression and suicidality in a VA primary care setting: 2 items are better than 1 item.
OBJECTIVE
To evaluate the psychometric properties of a single-item depression screen against validated scoring algorithms for the Patient Health Questionnaire (PHQ) and the utility of these algorithms in screening for depression and suicidality in a Department of Veterans Affairs (VA) primary care setting.


METHODS
Recruitment phase of a randomized trial.


METHODS
A total of 1211 Portland VA patients with upcoming primary care clinic appointments were administered by telephone a single item assessing depressed mood over the past year and the PHQ. The PHQ-9 (9 items) encompasses DSM-IV criteria for major depression, the PHQ-8 (8 items) excludes the thoughts of death or suicide item, and the PHQ-2 (2 items) assesses depressed mood and anhedonia. Patients whose responses suggested potential suicidality were administered 2 additional items assessing suicidal ideation. Patients receiving mental health specialty care were excluded.


RESULTS
Using the PHQ-9 algorithm for major depression as the reference standard, the VA single-item screen was specific (88%) but less sensitive (78%). A PHQ-2 score of > or =3 demonstrated similar specificity (91%) with high sensitivity (97%). For case finding, the PHQ-8 was similar to the PHQ-9. Approximately 20% of patients screened positive for moderate depression, 7% reported thoughts of death or suicide, 2% reported thoughts of harming themselves, and 1% had specific plans.


CONCLUSIONS
The PHQ-2 offers brevity and better psychometric properties for depression screening than the single-item screen. The PHQ-9 item assessing thoughts of death or suicide does not improve depression case finding; however, one third of patients endorsing this item reported recent active suicidal ideation.
Corson
Kathryn
K
Portland VA Medical Center, Portland, OR 97207, USA. kathryn.corson@med.va.gov
Gerrity
Martha S
MS
Dobscha
Steven K
SK
D000368:Aged; D000465:Algorithms; D003151:Community Health Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D003866:Depressive Disorder / Q000145:classification / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009922:Oregon; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D018579:Patient Selection; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics / Q000295:instrumentation*; D012647:Self-Assessment; D013405:Suicide / Q000523:psychology*; D011795:Surveys and Questionnaires; D013689:Telephone; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*