title: Developing a brief depression screen and identifying associations with comorbid physical and psychological illness in Australian Gulf War veterans.
abstract: OBJECTIVE
  Major depression occurs frequently in veterans, and is associated with comorbid psychological and physical disorders and poorer quality of life. Depression can be difficult to detect in primary care, while lengthy assessment instruments can deter use. Our study aimed to develop a brief depression screen that could be used by veterans and caregivers, and then to compare the association between the brief screen and comorbidities and quality of life with that of a longer instrument.
  
  
  METHODS
  Our dataset comprised 1204 male Royal Australian Navy veterans of the 1990/91 Gulf War. Depressive symptoms were assessed using the General Health Questionnaire (GHQ-12), health-related quality of life by the Short-Form Health Survey (SF-12), major depression and comorbid psychiatric diagnoses such as posttraumatic disorder (PTSD) using Diagnostic and Statistical Manual (DSM-IV) criteria. Comorbid physical illnesses including musculoskeletal disorders, chronic fatigue and diabetes were examined.
  
  
  RESULTS
  A brief depression screen of three key self-reported symptoms was identified. Veterans with major depression present according to the screen were over four times more likely to have multisymptom illness or PTSD, and almost twice as likely to have musculoskeletal disorders. Having depression according to the brief screen and having at least one other physical or psychological condition was associated with poorer quality of life. Similar results were obtained for a longer screen based on all GHQ-12 items.
  
  
  CONCLUSIONS
  A 3 item depression screen performed as well as a 12 item one in identifying major depression, comorbid physical and psychological illness and poorer quality of life in veterans.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Centre for Adolescent Health, Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia. Electronic address: dean.mckenzie@monash.edu.au.
authors.forename: Dean P
authors.initials: DP
authors.lastname: McKenzie
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Malcolm R
authors.initials: MR
authors.lastname: Sim
authors.affiliation: Discipline of Psychiatry, Monash University, Melbourne, Australia.
authors.forename: David M
authors.initials: DM
authors.lastname: Clarke
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Forbes
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Jillian F
authors.initials: JF
authors.lastname: Ikin
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Helen L
authors.initials: HL
authors.lastname: Kelsall
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000175:diagnosis* / Q000523:psychology*; D003865:Major Depressive Disorder / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D003920:Diabetes Mellitus / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D015673:Fatigue Syndrome, Chronic / Q000453:epidemiology; D047830:Gulf War; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000175:diagnosis* / Q000523:psychology*; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications / Q000453:epidemiology; D009483:Neuropsychological Tests; D011788:Quality of Life; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires; D014728:Veterans / Q000523:psychology*
keywords: Comorbidity; Depression; Musculoskeletal disorders; Screening; Veterans