Screening for depression and suicidality in a VA primary care setting: 2 items are better than 1 item.

Kathryn Corson, Martha S. Gerrity, Steven Dobscha

Research output: Contribution to journalArticle

140 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate the psychometric properties of a single-item depression screen against validated scoring algorithms for the Patient Health Questionnaire (PHQ) and the utility of these algorithms in screening for depression and suicidality in a Department of Veterans Affairs (VA) primary care setting. STUDY DESIGN: Recruitment phase of a randomized trial. METHODS: A total of 1211 Portland VA patients with upcoming primary care clinic appointments were administered by telephone a single item assessing depressed mood over the past year and the PHQ. The PHQ-9 (9 items) encompasses DSM-IV criteria for major depression, the PHQ-8 (8 items) excludes the thoughts of death or suicide item, and the PHQ-2 (2 items) assesses depressed mood and anhedonia. Patients whose responses suggested potential suicidality were administered 2 additional items assessing suicidal ideation. Patients receiving mental health specialty care were excluded. RESULTS: Using the PHQ-9 algorithm for major depression as the reference standard, the VA single-item screen was specific (88%) but less sensitive (78%). A PHQ-2 score of > or =3 demonstrated similar specificity (91%) with high sensitivity (97%). For case finding, the PHQ-8 was similar to the PHQ-9. Approximately 20% of patients screened positive for moderate depression, 7% reported thoughts of death or suicide, 2% reported thoughts of harming themselves, and 1% had specific plans. CONCLUSIONS: The PHQ-2 offers brevity and better psychometric properties for depression screening than the single-item screen. The PHQ-9 item assessing thoughts of death or suicide does not improve depression case finding; however, one third of patients endorsing this item reported recent active suicidal ideation.

Original languageEnglish (US)
Pages (from-to)839-845
Number of pages7
JournalThe American journal of managed care
Volume10
Issue number11 Pt 2
StatePublished - Nov 2004

Fingerprint

Veterans
Primary Health Care
Depression
questionnaire
health
Health
suicide
death
Suicide
mood
psychometrics
Suicidal Ideation
Psychometrics
Surveys and Questionnaires
Anhedonia
telephone
mental health
Telephone
Diagnostic and Statistical Manual of Mental Disorders

ASJC Scopus subject areas

  • Nursing(all)
  • Medicine(all)
  • Health(social science)
  • Health Professions(all)

Cite this

Screening for depression and suicidality in a VA primary care setting : 2 items are better than 1 item. / Corson, Kathryn; Gerrity, Martha S.; Dobscha, Steven.

In: The American journal of managed care, Vol. 10, No. 11 Pt 2, 11.2004, p. 839-845.

Research output: Contribution to journalArticle

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