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HSR&D 2004 National Meeting Abstracts

2043. Brief Screens for Depression and Suicidality: 2 items are better than 1
Kathryn E Corson, PhD, Behavior Health and Clinical Neurosciences Division, Portland VAMC, MS Gerrity, Division of Hospital and Specialty Medicine, Portland VAMC, SK Dobscha, Behavior Health and Clinical Neurosciences Division, Portland VAMC

Objectives: We sought to evaluate the psychometric strength of a single-item measure used by the PVAMC primary care clinics for annual depression screening using the Patient Health Questionnaire (PHQ) as the reference standard. We also examined the prevalence of depression symptoms including suicidal ideation.

Methods: 1,240 patients due to be seen by primary care providers were phone-screened for inclusion in a clinical trial, “Improving Outcomes of Depression in Primary Care.” Patients were administered the single-item screen (“Have you felt depressed or sad most of the time in the past year?”) and a 2- or 9-item PHQ. When the 9th PHQ item regarding thoughts of death or suicide was endorsed, suicidal ideation was further assessed using two additional items we devised.

Results: Using the recommended PHQ-9 cutoff of 10 as a reference standard, the single-item depression screen is specific (93%) but only moderately sensitive (68%), whereas the 2-item PHQ demonstrates good specificity (88%) and sensitivity (95%). Approximately 20% of respondents had scores suggesting moderate or greater depression severity. 2.6% acknowledged thoughts of suicide and 1.5% expressed a specific suicide plan.

Conclusions: The 2-item version of the PHQ was superior to the single item in screening for cases of potential depression. A substantial number of veterans experience depressive symptoms requiring further assessment.

Impact: The nature of depression and goal of screening place sensitivity at a premium. Administering two items rather than one improves performance with minimal added time investment and should be considered in clinical practice.