Identifying patients with depression in the primary care setting - A more efficient method

Objective: To determine if there is a core subset of depressive symptoms th at 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 questionnair e measuring the following validation variables: functional status and well- being, disability days, somatic symptoms, depression severity, suicidal tho ughts, 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-rela ted variance in functional status and well-being, with 8.3% of patients hav ing 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 dep ression (kappa= 0.77; overall accuracy rate, 94%). There were significant d ifferences (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 variable s getting progressively worse in these 4 groups. A cutoff point of 2 core s ymptoms identified all but 3 patients with major depression and an addition al 5% of the entire sample without major depression who were significantly (P<.05) worse than patients without depression on each of the validation va riables. Conclusion: A strategy that includes the use of a 2-item depression screene r 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.