title: Using patient-centred consultation when screening for depression in elderly patients: a comparative pilot study.
abstract: OBJECTIVE
  Using validated screening instruments to detect depressive symptoms in the elderly has been recommended. The aim of this study was to compare a patient-centred consultation model with the PRIME-MD screening questionnaire, using the MADRS-S as reference for detecting depressive symptoms in an elderly primary care population.
  
  
  METHODS
  Comparative study.
  
  
  METHODS
  Primary care, Sweden.
  
  
  METHODS
  During an 11-month period 302 consecutive patients aged 60 and over attending a primary care centre were screened with the PRIME-MD and the Montgomery-Asberg Depression Rating Scale-Self-rated version (MADRS-S) instrument. The results were unknown to the GPs who used a structured, patient-centred consultation model comprising seven open-ended "key questions".
  
  
  METHODS
  Sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were calculated for the PRIME-MD screening questionnaire and the patient-centred consultation model using MADRS-S as reference for possible depression at two cut-off levels with 15% prevalence. Results. Sensitivity was lower for the consultation model than the PRIME-MD screening questionnaire: 78% and 98%, respectively. The GPs failed to identify every fifth patient using the lower cut-off (MADRS-S≥13) but the number of required diagnostic interviews decreased by almost 50%: 85 versus 162, respectively. PPV was 43% and 28%, respectively. Both instruments showed high sensitivity (93%) using the higher cut-off (MADRS-S≥20) and had high NPV: 95% and 99%, respectively.
  
  
  CONCLUSIONS
  The findings suggest that the consultation screening procedure might be as useful in everyday practice as the PRIME-MD screening questionnaire. Both screening procedures may also be useful for ruling out depressive symptoms.
authors.affiliation: Department of Primary Health Care, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden. maria.magnil@vgregion.se
authors.forename: Maria
authors.initials: M
authors.lastname: Magnil
authors.forename: Ronny
authors.initials: R
authors.lastname: Gunnarsson
authors.forename: Cecilia
authors.initials: C
authors.lastname: Björkelund
mesh_terms: D000368:Aged; D003863:Depression / Q000175:diagnosis*; D003866:Depressive Disorder / Q000175:diagnosis*; D005194:Family Practice; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018802:Patient-Centered Care; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013548:Sweden