Screening for Depression: Two Questions Versus Many.

TitleScreening for Depression: Two Questions Versus Many.
Publication TypeJournal Article
AuthorsWadhwani R, Ehde DM, Hauge J, Boag-Whitley T, Bombardier CH
JournalInternational Journal of MS Care

Introduction: Depression is a common and disabling condition associated with multiple sclerosis. A major challenge is rapid and accurate identification of people who need treatment. Recent research suggests that two depression-screening questions may perform almost as well as longer questionnaires. We examined the psychometric utility of two screening questions from the PRIME-MD study (Spitzer et al, 1994). Subjects: Subjects were 52 consecutive patients attending a specialized MS clinic. A trained assistant administered all measures as part of routine care. Demographic and medical data were obtained via chart review. Subjects were administered the 20-item Centers for Epidemiological Studies-Depression Scale (CES-D; Radloff, 1977), a widely used depression-screening tool chosen for its well-established psychometric properties and norms, ease of administration, and minimal emphasis on somatic symptoms which may be nonspecific for depression in people with neurological disease. The CES-D was used as the “gold standard” measure to which the two screening questions were compared. Results: Sixty-two percent screened positive for depression by the CES-D (cutoff > 16), and 50% by the two-item screen (cutoff > 1). Compared to the CES-D, the two-item screen had a sensitivity of 72%, a specificity of 85%, and a positive predictive value (PPV) of 88%. Overall agreement was 77%. Using a CES-D cutoff more likely to be indicative of major depression (> 21), the sensitivity, specificity, and PPV of the two-item screen were 76%, 68%, and 62%, respectively. Those determined to be depressed by the two-item screen did not differ from nondepressed on EDSS scores. They did report significantly worse fatigue and poorer general health, as well as a trend toward having poorer social support. Conclusion: Two simple depression-screening items hold some promise for identifying persons more likely to be depressed within a MS clinic population.

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