The use of a brief depression screen in older emergency department patients.
OBJECTIVE
To determine the sensitivity and specificity of a brief two-question depression screen for the detection of depression in older emergency department (ED) patients, and to determine the prevalence of depression in this population.


METHODS
This was a prospective, observational study. Participants included a convenience sampling of ED patients 70 years and older presenting to an urban teaching hospital over a 17-month period. Exclusions were refusal to participate, inability to communicate, and critical illness. Subjects were screened for depression with the previously validated Short Form Geriatric Depression Scale (SFGDS). Standardized scores on the SFGDS were used to determine the prevalence of depression. Patients were then given a previously published two-question depression screen, and results were compared with the SFGDS as the criterion standard. Sensitivity, specificity, and prevalence data are reported as proportions with 95% confidence intervals (95% CIs).


RESULTS
Two hundred sixty-seven of 327 eligible patients were enrolled. Forty-four (17%; 95% CI = 12% to 21%) scored positive for depression on the SFGDS. The sensitivity of the brief two-question depression screen was 84% (37/44; 95% CI = 70% to 93%), with a specificity of 61% (136/223; 95% CI = 55% to 67%) using a cutoff score of at least one of two positive responses.


CONCLUSIONS
Depression is fairly prevalent in older ED patients. The brief two-question depression screen, using a cutoff score of at least one positive response, is promising for ED use. However, given lower specificity, patients scoring positive for depression should be followed up with a more specific tool such as the self-administered SFGDS prior to referral for further evaluation and treatment.
Hustey
Fredric M
FM
Department of Emergency Medicine-E-19, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. husteyf@ccf.org
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D004635:Emergency Medicine / Q000295:instrumentation* / Q000379:methods; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005853:Geriatrics / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data*; D009820:Ohio / Q000453:epidemiology; D015995:Prevalence; D044469:Racial Groups / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D017678:Sex Distribution
D000928:Antidepressive Agents