An Even Simpler Depression Screening Test

Summarized by Robert W. Griffith, MD
February 27, 2004

Introduction

There are several questionnaires available to help people who worry that they may have depression. Many are carried on health web sites. The trouble with these tests is that family doctors don't often have time to go through all the questions - they're just too cumbersome. New Zealand physicians have sought to improve the situation using a quiz that contains just two questions. They've published their evaluation of this approach in the British Medical Journal.

What was done

Fifteen general practitioners (family doctors) in Auckland, New Zealand, were chosen to test the concept in patients who weren't taking psychotropic drugs (e.g. anti-anxiety, antidepressant, or mood-altering drugs). At any time during consultation with a patient, the doctor asked the two questions:

• "During the past month, have you often been bothered by feeling down, depressed, or hopeless?"
• "During the past month, have you often been bothered by little interest or pleasure in doing things?"

If the answer to either question was "yes", the screening was considered positive, and the patient was asked to complete a computerized evaluation-of-mood questionnaire, which was used to decide whether there was a definite diagnosis of depression or not.

Analyses were done to determine the 'sensitivity' (what percentage of positive cases will the test detect) and 'specificity' (what percentage of people without the disease are reported as being negative) of using these two questions, compared with the actual diagnosis made by the extensive computerized interview.

What was found

Over 670 patients were asked by their doctors to participate in the study. Of these, 476 agreed; there were 142 men and 330 women (the gender wasn't reported in 4 cases). After exclusions because of medications being taken, 421 patients were asked the two questions. Their average age was 46, ranging from 16 to 90.

One hundred and fifty-seven patients answered "yes" to one or other of the questions. Following the computerized interview, it was found that 28 of these (18%) were actually diagnosed with depression, while only one of the 264 patients who replied "no" to each question was actually found to have depression.

These results showed that the sensitivity of the 2-question test was 97% - i.e. 97 patients out of 100 with depression would answer "yes" to one or other question. Virtually all the patients - 99.6% - who answered "no" to both questions were not depressed.

The specificity of the 2-question test was less satisfactory. Sixty-seven out of 100 patients who answered "yes" to either question did not, in fact, have a diagnosis of depression.

Comment

The analysis showed that these two questions asked by the doctor will reveal most cases of depression. If the answer is "yes" to either question, the patient should have a full diagnostic interview (possibly computerized to save time and avoid 'observer's bias'). In fact, about 2 out of 3 of these patients will be found not to have depression.

But, more importantly, virtually all those people with depression will have replied "yes" to one or both questions, and will be sent for a diagnostic interview, after which treatment can be started. Obviously, the test is a good way to rule out depression.

At present, the shortest screening test for depression used in family practice is the 7-question Beck Depression Inventory, administered in writing. Clearly the 2-question test described here would be very easy for doctors to fit into their routine patient consultation, and it would be likely to find all cases of depression; non-recognition of depression is a serious error in patient care.

Source

• Screening for depression in primary care with two verbally asked questions: cross sectional study. B. Arroll, N. Khin, N. Kerse, BMJ, 2003, vol. 327, pp. 1144--1146

Related Links
Depression: A Risk Factor for Heart Disease in Older People
Walk Away from Depression?
Understanding and Helping the Suicidal Person
'Beating the Senior Blues'
When the Problem is 'Depression'

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