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Original Investigation
December 7/21, 1998

Identifying Patients With Depression in the Primary Care Setting: A More Efficient Method

Author Affiliations

From the Allegheny University of the Health Sciences, Philadelphia, Pa (Dr Brody); Albert Einstein College of Medicine (Dr Hahn), and the New York State Psychiatric Institute (Dr Spitzer and Ms Williams), New York, NY; Indiana University Medical Center, Indianapolis (Dr Kroenke); University of Wisconsin, Madison (Dr Linzer); and University of South Alabama College of Medicine, Mobile (Dr deGruy).

Arch Intern Med. 1998;158(22):2469-2475. doi:10.1001/archinte.158.22.2469
Abstract

Objective  To determine if there is a core subset of depressive symptoms that could be used to efficiently diagnose depression after administering the 2-item PRIME-MD a screening questionnaire for depression.

Methods  One thousand patients selected randomly and by convenience from 4 primary care clinics were assessed by PRIME-MD and completed a questionnaire measuring the following validation variables: functional status and well-being, disability days, somatic symptoms, depression severity, suicidal thoughts, health care utilization, and the physician-patient relationship.

Results  Four symptoms (sleep disturbance, anhedonia, low self-esteem, and decreased appetite) accounted for virtually all the depression symptom-related variance in functional status and well-being, with 8.3% of patients having 2 of these symptoms and 8.2% having 3 or 4 of these symptoms. There was excellent agreement between diagnosis based on core symptoms and major depression (κ= 0.77; overall accuracy rate, 94%). There were significant differences (P<.001) among patients with negative depression screen, 0 to 1, 2, and 3 to 4 core symptoms with scores on each of the validation variables getting progressively worse in these 4 groups. A cutoff point of 2 core symptoms identified all but 3 patients with major depression and an additional 5% of the entire sample without major depression who were significantly (P<.05) worse than patients without depression on each of the validation variables.

Conclusion  A strategy that includes the use of a 2-item depression screener followed by the evaluation of 4 core depressive symptoms is an efficient and effective way of identifying and classifying primary care patients with depression in need of clinical attention.

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