#203 Got Depression? I can answer that in two questions!

CLINICAL QUESTION

QUESTION CLINIQUE

What is the diagnostic accuracy of the 2-question screen for identifying depression in primary care?

BOTTOM LINE

RÉSULTAT FINAL

The 2-question screen is good at ruling out (but not ruling in) depression in primary care. Up to 50% of patients will test positive and should have more thorough evaluation to confirm depression diagnosis. Whether screening alters outcomes is debatable, but the 2-question screen may be reasonable for case-finding or screening higher risk patients.

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session

EVIDENCE

DONNÉES PROBANTES

2-Question Screen (positive screen=yes to ≥1 question, negative=no to both):

“During the past month have you often been bothered by:
1. Feeling down, depressed or hopeless?
2. Having little interest or pleasure in doing things?”

Primary care: Three cohort studies^1-3 (total 1,893 patients), 23-37% of patients tested positive to screening, 5-18% actually had depression:

Sensitivity: 96-97% (if no to both questions, depression ruled out ~96% of time).
Specificity: 57-78% (if yes to ≥1 question, patients are depressed ~70% of time).

Systematic reviews of different short depression screens^4,5 or pertaining to only geriatric patients⁶ found similar results, but up to half of geriatric patients may test positive.⁷ No studies evaluating the effects of screening on patient outcomes in North American context were found. Context:

Since the 2-question screen is better at ruling-out than ruling-in depression, when a patient answers “yes” to ≥1 question, more formal evaluation (example Patient Health Questionnaire (PHQ)-9 or Geriatric Depression Scale) is needed to diagnose depression.
- Example: In adults, PHQ-9 score ³10 has a sensitivity and specificity of 88%:^8,9
  - PHQ-9: Range of scores 0-27, higher worse.
Adding “Is this something with which you would like help?”2 or frequency of symptoms to the 2-question screen (example PHQ-2) may improve depression diagnosis.^5,10,11
- Asking only 1-question not as accurate in identifying depression.⁴
Guidelines differ on depression screening recommendations from screening all adults12 to not screening at all,13 to only those with a history of depression, chronic health problems, or post-partum women.¹⁴
- Effectiveness of screening depends on disease prevalence and impacts opportunity cost.
People with chronic illnesses,15 substance abuse history, First Nations descent, and post-partum women have higher depression rates.¹⁴

Latest Tools for Practice

Derniers outils pour la pratique

Allison Paige MD CCFP

#364 Facing the Evidence in Acne, Part II: Oral Antibiotics

How effective are oral antibiotics in treating acne of at least mild-moderate severity?

Read Lire 0.25 credits available Crédits disponibles

Bradley LeDrew PharmD candidate

#363 Making a difference in indifference? Medications for apathy in dementia

In patients with dementia, how safe and effective are stimulants, antidepressants, and antipsychotics for treating apathy?

Read Lire 0.25 credits available Crédits disponibles

Allison Paige MD CCFP

#362 Facing the Evidence in Acne, Part I: Oral contraceptives and spironolactone in females

How effective are combined oral contraceptives (COC) and spironolactone for treating acne of at least mild-moderate severity in females?

Read Lire 0.25 credits available Crédits disponibles

January 15, 2018

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session

🔒 Complete Activity

🔒 Compléter l’activité

Author(s)

Auteur(s)

Caitlin R Finley BHSc MSc
Michael Kolber BSc MD CCFP MSc

1. Arroll B, Khin N, Kerse N. BMJ. 2003; 327:1144-6.

2. Arroll B, Goodyear-Smith F, Kerse N, et al. BMJ. 2005; 331:884.

3. Whooley M, Alvins AL, Miranda J, et al. J Gen Internal Med. 1997; 12:439-45.

4. Mitchell AJ, Coyne JC. Br J Gen Pract. 2007; 57:144-51.

5. Mitchell AJ, Yadegarfar M, Gill J, et al. B J Psych Open. 2016; 2:127-38.

6. Tsoi KKF, Chan JYC, Hirai HW, et al. Br J Psychiatry. 2017; 210:255-60.

7. Bosanquet K, Mitchell N, Gabe R, et al. J Affect Disord. 2015; 182:39-43.

8. Kroenke K, Spitzer RL, Williams JBW. J Gen Intern Med. 2001; 16:606-13.

9. The Patient Health Questionnaire (PHQ-9) 1999 Pfizer. Available at: http://www.cqaimh.org/pdf/tool_phq9.pdf. Last Accessed: August 28, 2017.

10. Arroll B, Goodyear-Smith F, Crengle S, et al. Ann Fam Med. 2010; 8:348-53.

11. Kroenke K, Spitzer RL, Williams JBW. Med Care. 2003; 41:1284-92.

12. Siu AL, US Preventive Services Task Force. JAMA. 2016; 315:380-7.

13. Canadian Task Force on Preventive Health Care. CMAJ. 2013; 185:775-82.

14. National Collaborating Centre for Mental Health. NICE Clinical Guidelines, no. 90. British Psychological Society; 2009. Available at: https://www.nice.org.uk/guidance/cg90/chapter/Key-priorities-for-implementation. Last Accessed: August 28, 2017.

Tools for Practice Outils pour la pratique