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Effect of the addition of a "help" question to two screening questions on specificity for diagnosis of depression in general practice: diagnostic validity study.

Arroll B, Goodyear-Smith F, Kerse N, Fishman T, Gunn J

Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Private Bag 92019, Auckland, New Zealand. b.arroll@auckland.ac.nz

OBJECTIVE: To determine the validity of two written screening questions for depression with the addition of a question inquiring if help is needed. DESIGN: Cross sectional validation study. SETTING: 19 general practitioners in six clinics in New Zealand. PARTICIPANTS: 1025 consecutive patients receiving no psychotropic drugs. MAIN OUTCOME MEASURES: Sensitivity, specificity, and likelihood ratios of the two screening questions, the help question, combinations of the screening and help questions, and diagnosis by general practitioners. RESULTS: The help question alone had a sensitivity of 75% (95% confidence interval 60% to 85%) and a specificity of 94% (93% to 96%). The positive likelihood ratio for the help question was 13.0 (9.5 to 17.8) and the negative likelihood ratio was 0.27 (0.17 to 0.44). The likelihood ratio for patients wanting help today was 17.5 (11.8 to 31.9). The general practitioner diagnosis had a sensitivity of 79% (65% to 88%) and a specificity of 94% (92% to 95%). CONCLUSION: Adding a question inquiring if help is needed to the two screening questions for depression improves the specificity of a general practitioner diagnosis of depression.

Published 14 October 2005 in BMJ, 331(7521): 884.
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