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June 26, 1996

Treatment of Chronic Depression

JAMA. 1996;275(24):1884. doi:10.1001/jama.1996.03530480025033

To the Editor.  —The discussion by Dr Goodwin1 of procedures for diagnosing depression states: "Although not used to establish the diagnosis, self-administered screening instruments, such as the General Health Questionnaire (with its subscale for depression), the Beck Depression Inventory, the Zung Self-rating Scale, and the PRIME-MD screening test, can be valuable aids in finding patients who require a more thorough diagnostic evaluation.... Although these screening instruments are sensitive (few false negatives), they are not specific (many false positives)." Although 1 component of PRIME-MD is a 1-page screening procedure, patients who are screened positive are then evaluated by the physician with a brief structured diagnostic interview. Thus, unlike the screening procedures mentioned by Goodwin, PRIME-MD is a diagnostic procedure. Furthermore, in the PRIME-MD 1000 study2 using the psychiatric diagnoses of mental health professionals who made blind interviews of patients as the criterion standard, diagnoses made by primary care physicians