title: An assessment of the screening performance of a single-item measure of depression from the Edmonton Symptom Assessment Scale among chronically ill hospitalized patients.
abstract: BACKGROUND
  Few studies have examined the validity of using a single item from the Edmonton Symptom Assessment Scale (ESAS) for screening for depression.
  
  
  OBJECTIVE
  To examine the screening performance of the single-item depression question from the ESAS in chronically ill hospitalized patients.
  
  
  METHODS
  A total of 162 chronically ill inpatients aged 65 and older completed a survey after admission that included the well-validated, 15-item Geriatric Depression Scale (GDS-15) and four single-item screening questions for depression based on the ESAS question, using two different time frames ("now" and "in the past 24 hours") and two response categories (a 0-10 numeric rating scale [NRS] and a categorical scale: none, mild, moderate, and severe).
  
  
  RESULTS
  The GDS-15 categorized 20% (n = 33) of participants as possibly being depressed with a score ≥ 6. The NRS for depression "now" achieved the highest level of sensitivity at a cutoff ≥ 1 (68.8%), and an acceptable level of specificity was obtained at a cutoff of ≥ 5 (82.2%). For depression "in the past 24 hours," a cutoff of ≥ 1 achieved a sensitivity of 68.8% and a cutoff of ≥ 7 a specificity of 80.3%. For the categorical scale, a cutoff of "none" provided the best level of sensitivity for depression "now" (65.6%) and "in the past 24 hours" (81.3%), with an acceptable level of specificity being obtained at ≥"mild" (68.8%) and ≥"moderate" (68.8%), respectively.
  
  
  CONCLUSIONS
  These single-item measures were not effective in screening for probable depression in chronically ill patients regardless of the time frame or the response format used, but a cutoff of ≥ 5 or "mild" or greater did achieve sufficient specificity to raise clinical suspicion.
authors.affiliation: Palliative Care Program, University of California at San Francisco, San Francisco, California 94143-0903, USA. stevep@medicine.ucsf.edu
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: Pantilat
authors.forename: David L
authors.initials: DL
authors.lastname: O'Riordan
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Dibble
authors.forename: C Seth
authors.initials: CS
authors.lastname: Landefeld
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000523:psychology*; D003863:Depression / Q000175:diagnosis*; D003866:Depressive Disorder / Q000175:diagnosis*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008403:Mass Screening; D011594:Psychometrics; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires