title: Diagnostic accuracy of the Whooley questions for the identification of depression: a diagnostic meta-analysis.
abstract: OBJECTIVE
  To determine the diagnostic accuracy of the Whooley questions in the identification of depression; and, to examine the effect of an additional 'help' question.
  
  
  METHODS
  Systematic review with random effects bivariate diagnostic meta-analysis. Search strategies included electronic databases, examination of reference lists, and forward citation searches.
  
  
  METHODS
  Studies were included that provided sufficient data to calculate the diagnostic accuracy of the Whooley questions against a gold standard diagnosis of major depression.
  
  
  METHODS
  Descriptive information, methodological quality criteria, and 2 × 2 contingency tables were extracted.
  
  
  RESULTS
  Ten studies met inclusion criteria. Pooled sensitivity was 0.95 (95% CI 0.88 to 0.97) and pooled specificity was 0.65 (95% CI 0.56 to 0.74). Heterogeneity was low (I(2)=24.1%). Primary care subgroup analysis gave broadly similar results. Four of the ten studies provided information on the effect of an additional help question. The addition of this question did not consistently improve specificity while retaining high sensitivity as reported in the original validation study.
  
  
  CONCLUSIONS
  The two-item Whooley questions have high sensitivity and modest specificity in the detection of depression. The current evidence for the use of an additional help question is not consistent and there is, as yet, insufficient data to recommend its use for screening or case finding.
  
  
  BACKGROUND
  CRD42014009695.
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Katharine
authors.initials: K
authors.lastname: Bosanquet
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Della
authors.initials: D
authors.lastname: Bailey
authors.affiliation: Department of Health Sciences, University of York, York, UK Hull York Medical School, University of York, York, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Gilbody
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, UK.
authors.forename: Melissa
authors.initials: M
authors.lastname: Harden
authors.affiliation: Department of Health Sciences, University of York, York, UK Hull York Medical School, University of York, York, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Manea
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Nutbrown
authors.affiliation: Department of Health Sciences, University of York, York, UK Hull York Medical School, University of York, York, UK.
authors.forename: Dean
authors.initials: D
authors.lastname: McMillan
mesh_terms: D003863:Depression / Q000175:diagnosis*; D006801:Humans; D015233:Models, Statistical; D011569:Psychiatric Status Rating Scales; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
keywords: Whooley questions; diagnostic accuracy; diagnostic meta-analysis; major depression; screening