CASE-FINDING INSTRUMENTS FOR DEPRESSION IN PRIMARY-CARE SETTINGS

Objective: To evaluate the usefulness of case-finding instruments for identifying patients with major depression in primary care settings. D ata Sources: A MEDLINE search of the English-language medical literatu re; bibliographies of selected papers; and experts. Study Selection: S tudies that were done in primary care settings with unselected patient s and that compared case-finding instruments with accepted diagnostic criterion standards for major depression were selected. Data Synthesis : 9 case-finding instruments were assessed in 18 studies. More than 15 000 patients received screening with a case-finding instrument; approx imately 5300 of these received criterion standard assessment. Case-fin ding instruments ranged in length from 2 to 28 questions. Average admi nistration times ranged from less than 2 minutes to 6 minutes. Sensiti vities and specificities for detecting major depression ranged from 67 % to 99% and from 40% to 95%, respectively. No significant differences between instruments were found. Overall sensitivity was 84% (95% CI, 79% to 89%); overall specificity was 72% (CI, 67% to 77%). If a case-f inding instrument were administered to 100 primary care patients with a 5% prevalence of major depression, the clinician could expect that 3 1 patients would screen positive, that 4 of the 31 would have major de pression, and that 1 patient with major depression would not be identi fied. Conclusions: Several instruments with reasonable operating chara cteristics are available to help primary care clinicians identify pati ents with major depression. Because the operating characteristics of t hese instruments are similar, selection of a particular instrument sho uld depend on issues such as feasibility, administration and scoring t imes, and the instruments' ability to serve additional purposes, such as monitoring severity or response to therapy.