title: Screening for depression in the older long-term unemployed.
abstract: BACKGROUND
  Misdiagnosis and undertreatment of depression in older, long-term unemployed people may not only pose a serious medical problem, but may also be an obstacle for their vocational reintegration. Screening for depression could be a first step to increasing treatment rates within this high-risk group. Therefore, the WHO-5 Well-Being Index was tested for its validity in unemployment offices.
  
  
  METHODS
  Three hundred and sixty-five participants in a German programme for the vocational reintegration of long-term unemployed people were screened with the WHO-5 Well-Being Index. In 104 of these subjects, ICD-10 diagnoses were made using DIA-X Structured Clinical Interview.
  
  
  RESULTS
  Using the DIA-X data as a gold standard, the WHO-5 Well-Being Index obtained satisfactory results for sensitivity (82.5%) and specificity (70.3%) as a screening tool for affective disorders when used with an adjusted cut-off-point of < or = 12. While none of the 18.5% male participants diagnosed with major depression received treatment, half of the 24% of female participants with major depression received treatment.
  
  
  CONCLUSIONS
  Screening with the WHO-5 within unemployment offices is useful to detect people with depressive disorders. Many of them do not receive optimal treatment and can be motivated to seek professional help. Reducing depression by better treatment will also increase the chances of reemployment.
authors.affiliation: Dept. of Psychiatry, Ludwig-Maximilian-University Munich, Nussbaumstrasse 7, 80336 Munich, Germany. iris.liwowsky@med.uni-muenchen.de
authors.forename: Iris
authors.initials: I
authors.lastname: Liwowsky
authors.forename: Dietmar
authors.initials: D
authors.lastname: Kramer
authors.forename: Roland
authors.initials: R
authors.lastname: Mergl
authors.forename: Anke
authors.initials: A
authors.lastname: Bramesfeld
authors.forename: Antje-Kathrin
authors.initials: AK
authors.lastname: Allgaier
authors.forename: Ernst
authors.initials: E
authors.lastname: Pöppel
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hegerl
mesh_terms: D000367:Age Factors; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D038801:International Classification of Diseases / Q000706:statistics & numerical data; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D009786:Occupational Health Services / Q000379:methods / Q000458:organization & administration; D011237:Predictive Value of Tests; D015995:Prevalence; D016730:Program Development / Q000379:methods; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014478:Unemployment / Q000523:psychology / Q000706:statistics & numerical data*