title: Adult depression screening in Saudi primary care: prevalence, instrument and cost.
abstract: BACKGROUND
  By the year 2020 depression would be the second major cause of disability adjusted life years lost, as reported by the World Health Organization. Depression is a mental illness which causes persistent low mood, a sense of despair, and has multiple risk factors. Its prevalence in primary care varies between 15.3-22%, with global prevalence up to 13% and between 17-46% in Saudi Arabia. Despite several studies that have shown benefit of early diagnosis and cost-savings of up to 80%, physicians in primary care setting continue to miss out on 30-50% of depressed patients in their practices.
  
  
  METHODS
  A cross sectional study was conducted at three large primary care centers in Riyadh, Saudi Arabia aiming at estimating point prevalence of depression and screening cost among primary care adult patients, and comparing Patient Health Questionnaires PHQ-2 with PHQ-9. Adult individuals were screened using Arabic version of PHQ-2 and PHQ-9. PHQ-2 scores were correlated with PHQ-9 scores using linear regression. A limited cost-analysis and cost saving estimates of depression screening was done using the Human Capital approach.
  
  
  RESULTS
  Patients included in the survey analysis were 477, of whom 66.2% were females, 77.4% were married, and nearly 20% were illiterate. Patients exhibiting depressive symptoms on the basis of PHQ9 were 49.9%, of which 31% were mild, 13.4% moderate, 4.4% moderate-severe and 1.0% severe cases. Depression scores were significantly associated with female gender (p-value 0.049), and higher educational level (p-value 0.002). Regression analysis showed that PHQ-2 & PHQ-9 were strongly correlated R = 0.79, and R2 = 0.62. The cost-analysis showed savings of up to 500 SAR ($133) per adult patient screened once a year.
  
  
  CONCLUSIONS
  The point prevalence of screened depression is high in primary care visitors in Saudi Arabia. Gender and higher level of education were found to be significantly associated with screened depression. Majority of cases were mild to moderate, PHQ-2 was equivocal to PHQ 9 in utility and that screening for depression in primary care setting is cost saving.
authors.affiliation: Board Eligible Resident, Family Medicine Department, King Abdulaziz Medical City-National Guard, Riyadh, Saudi Arabia. dwaqs@hotmail.com.
authors.forename: Waleed
authors.initials: W
authors.lastname: Al-Qadhi
authors.forename: Saeed
authors.initials: S
authors.lastname: Ur Rahman
authors.forename: Mazen S
authors.initials: MS
authors.lastname: Ferwana
authors.forename: Imad Addin
authors.initials: IA
authors.lastname: Abdulmajeed
mesh_terms: D000328:Adult; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D015995:Prevalence; D011320:Primary Health Care / Q000191:economics*; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D011795:Surveys and Questionnaires