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A More Efficient Method

David S. Brody, MD; Steven R. Hahn, MD; Robert L. Spitzer, MD; Kurt Kroenke, MD; Mark Linzer, MD; Frank V. deGruy III, MD; Janet B. W. Williams, DSW

Arch Intern Med. 1998;158:2469-2475.

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 (= 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.

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).

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