#203 Got Depression? I can answer that in two questions!
CLINICAL QUESTION
What is the diagnostic accuracy of the 2-question screen for identifying depression in primary care?
BOTTOM LINE
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.
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EVIDENCE
2-Question Screen (positive screen=yes to ≥1 question, negative=no to both):
- “During the past month have you often been bothered by:
- Feeling down, depressed or hopeless?
- Having little interest or pleasure in doing things?”
- 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).
- 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.
- Example: In adults, PHQ-9 score ³10 has a sensitivity and specificity of 88%:8,9
- 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
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