Journal of General Internal Medicine

, Volume 12, Issue 7, pp 439–445 | Cite as

Case-finding instruments for depression

Two questions are as good as many
  • Mary A. Whooley
  • Andrew L. Avins
  • Jeanne Miranda
  • Warren S. Browner
Original Articles



To determine the validity of a two-question case-finding instrument for depression as compared with six previously validated instruments.


The test characteristics of a two-question case-fidning instrument that asks about depressed mood and anhedonia were compared with six common case-finding instruments, using the Quick Diagnostic Interview Schedule as a criterion standard for the diagnosis of major depression.


Urgent care clinic at the San Francisco Department of Veterans Affairs Medical Center.


Five hundred thirty-six consecutive adult patients without mania or schizophrenia.

Measurements and main results

Measurements were two questions from the Primary Care Evaluation of Mental Disorders patient questionnaire, both the long and short forms of the Center for Epidemiologic Studies Depression Scale, both the long and short forms of the Beck Depression Inventory, the Symptom-Driven Diagnostic System for Primary Care, the Medical Outcomes Study depression measure, and the Quick Diagnostic Interview Schedule. The prevalence of depression, as determined by the standardized interview, was 18% (97 of 536). Overall, the case-finding instruments had sensitivities of 89% to 96% and specificities of 51% to 72% for diagnosing major depression. A positive response to the two-item instrument had a sensitivity of 96% (95% confidence interval [CI], 90–99%) and a specificity of 57% (95% CI 53–62%). Areas under the receiver operating characteristic curves were similar for all of the instruments, with a range of 0.82 to 0.89.


The two-question case-finding instrument is a useful measure for detecting depression in primary care. It has similar test characteristics to other case-finding instruments and is less time-consuming.

Key Words

depression case-finding instruments 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Depression Guideline Panel. Depression in Primary Care, Vol 1: Detection and Diagnosis. Clinical Practice Guideline. Washington, DC: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; 1993. AHCPR 93-0550.Google Scholar
  2. 2.
    Johnson J, Weissman MM, Klerman GL. Service utilization and social morbidity associated with depressive symptoms in the community. JAMA. 1992;267:1478–83.PubMedCrossRefGoogle Scholar
  3. 3.
    Wells KB, Stewart A, Hays RD, et al. The functioning and well-being of depressed patients. Results from the Medical Outcomes Study. JAMA. 1989;262:914–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Broadhead WE, Blazer DG, George LK, Tse CK. Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA. 1990;264:2524–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Simon GE. Psychiatric disorder and functional somatic symptoms as predictors of health care use. Psychiatr Med. 1992:10:49–59.PubMedGoogle Scholar
  6. 6.
    Katon W, Berg AO, Robins AJ, Risse S. Depression—medical utilization and somatization. West J Med. 1986;144:564–8.PubMedGoogle Scholar
  7. 7.
    Spitzer RL, Kroenke K, Linzer M, et al. Health-related quality of life in primary care patients with mental disorders. [Results from the PRIME-MD 1000 study. JAMA. 1995;274:1511–7.] JAMA 1993; 270:1819–25.CrossRefGoogle Scholar
  8. 8.
    Frasure-Smith N, Lesperance F, Talajic M. Depression following myocardial infarction. Impact on 6-month survival. Published erratum appears in JAMA. 1994;271:1082.Google Scholar
  9. 9.
    Greenberg PE, Stiglin LE, Finkelstein SN, Berndt ER. The economic burden of depression in 1990. J Clin Psychiatry. 1993;54:405–18.PubMedGoogle Scholar
  10. 10.
    Shurman RA, Kramer PD, Mitchell JB. The hidden mental health network. Treatment of mental illness by nonpsychiatrist physicians. Arch Gen Psychiatry. 1985;42:89–94.Google Scholar
  11. 11.
    Simon GE, Von Korff M. Recognition, management, and outcomes of depression in primary care. Arch Fam Med. 1995;4:99–105.PubMedCrossRefGoogle Scholar
  12. 12.
    Von Korff M, Shapiro S, Burke JD, et al. Anxiety and depression in a primary care clinic. Comparison of Diagnostic Interview Schedule, General Health Questionnaire, and practitioner assessments. Arch Gen Psychiatry. 1987;44:152–6.Google Scholar
  13. 13.
    Beck A, Ward C, Mendelson M. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:53–63.Google Scholar
  14. 14.
    Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measurement. 1977;1:385–401.CrossRefGoogle Scholar
  15. 15.
    Burnam MA, Wells KB, Leake B, Landsverk J. Development of a brief screening instrument for detecting depressive disorders. Med Care. 1988;26:775–89.PubMedCrossRefGoogle Scholar
  16. 16.
    Broadhead WE, Leon AC, Weissman MM, et al. Development and validation of the SDDS-PC screen for multiple mental disorders in primary care. Arch Fam Med. 1995;4:211–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatric Res. 1982;17:37–49.CrossRefGoogle Scholar
  18. 18.
    Żung W. A self-rating depression scale. Arch Gen Psychiatry. 1965;12:63–70.PubMedGoogle Scholar
  19. 19.
    Rush AJ, Giles DE, Schlesser MA, Fulton CL, Weissenburger J. Burns C. The Inventory for Depressive Symptomatology (IDS): preliminary findings. Psychiatry Res. 1986;18:65–87.PubMedCrossRefGoogle Scholar
  20. 20.
    Cleary PD, Goldberg ID, Kessler LG, Nycz GR. Screening for mental disorder among primary care patients. Usefulness of the General Health Questionnaire. Arch Gen Psychiatry. 1982;39:837–40.PubMedGoogle Scholar
  21. 21.
    Rost K, Burnam MA, Smith GR. Development of screeners for depressive disorders and substance disorder history. Med Care. 1993;31:189–200.PubMedCrossRefGoogle Scholar
  22. 22.
    Andersen SM, Harthorn BH. The recognition, diagnosis, and treatment of mental disorders by primary care physicians. Med Care. 1989;27:869–86.PubMedCrossRefGoogle Scholar
  23. 23.
    Weissman MM, Olfson M, Leon AC, et al. Brief diagnostic interviews (SDDS-PC) for multiple mental disorders in primary care. A pilot study. Arch Fam Med. 1995;4:220–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association: 1994.Google Scholar
  25. 25.
    Spitzer RL, Williams JB, Kroenke K, et al. Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA. 1994;272:1749–56.PubMedCrossRefGoogle Scholar
  26. 26.
    Andersen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10:77–84.Google Scholar
  27. 27.
    Beck AT, Beck RW. Screening depressed patients in family practice. A rapid technic. Postgrad Med. 1972;52:81–5.PubMedGoogle Scholar
  28. 28.
    Ewing JA. Detecting alcoholism. The CAGE questionnaire. JAMA. 1984;252:1905–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Robins LN, Helzer JE, Croughan J, Ratcliff KS. National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Arch Gen Psychiatry. 1981;38:381–9.PubMedGoogle Scholar
  30. 30.
    Bucholz KK, Marion SL, Shayka JJ, Marcus SC, Robins LN. A short computer interview for obtaining psychiatric diagnoses. Psychiatr Serv. 1996;47:293–7.PubMedGoogle Scholar
  31. 31.
    Stata Statistical Software: release 5.0. College Station, Tex.: Stata Corp: 1996.Google Scholar
  32. 32.
    Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical Epidemiology: A Basic Science For Clinical Medicine. Boston, Mass.: Little, Brown and Co.; 1991.Google Scholar
  33. 33.
    Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 1983;148:839–43.PubMedGoogle Scholar
  34. 34.
    Mulrow CD, Williams J Jr, Gerety MB, Ramirez G, Montiel OM, Kerber C. Case-finding instruments for depression in primary care settings. Ann Intern Med. 1995;122:913–21.PubMedGoogle Scholar
  35. 35.
    Walker RD, Howard MO, Lambert MD, Suchinsky R. Psychiatric and medical comorbidities of veterans with substance use disorders. Hosp Commun Psychiatry. 1994;45:232–7.Google Scholar
  36. 36.
    Kukull WA, Koepsell TD, Inui TS, et al. Depression and physical illness among elderly general medical clinic patients. J Affect Disord. 1986;10:153–62.PubMedCrossRefGoogle Scholar
  37. 37.
    Wells KB, Hays RD, Burnam MA, Rogers W, Greenfield S, Ware J Jr. Detection of depressive disorder for patients receiving prepaid or fee-for-service care. Results from the Medical Outcomes Study. JAMA. 1989;262:3298–302.PubMedCrossRefGoogle Scholar
  38. 38.
    Elkin I, Gibbons RD, Shea MT. et al. Initial severity and differential treatment outcome in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. J Consult Clin Psychol. 1995;63:841–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Magruder-Habib K, Żung WW, Feussner JR. Improving physicians' recognition and treatment of depression in general medical care. Results from a randomized clinical trial. Med Care. 1990;28:239–50.PubMedCrossRefGoogle Scholar
  40. 40.
    Tiemens BG, Ormel J, Simon GE. Occurrence, recognition, and outcome of psychological disorders in primary care. Am J Psychiatry. 1996;153:636–44.PubMedGoogle Scholar
  41. 41.
    Callahan CM, Hendrie HC, Dittus RS, Brater DC, Hui SL, Tierney WM. Improving treatment of late life depression in primary care: a randomized clinical trial. J Am Geriatr Soc. 1994;42:839–46.PubMedGoogle Scholar
  42. 42.
    Schulberg HC, Block MR, Madonia MJ, et al. Treating major depression in primary care practice. Eight-month clinical outcomes. Arch Gen Psychiatry. 1996;53:913–9.PubMedGoogle Scholar
  43. 43.
    Katon W, Von Korff M, Lin E, et al. Collaborative management to achieve treatment guidelines. Impact on depression in primary care. JAMA. 1995;273:1026–31.PubMedCrossRefGoogle Scholar
  44. 44.
    Coyne JC, Schwenk TL, Fechner-Bates S. Nondetection of depression by primary care physicians reconsidered. Gen Hosp Psychiatry. 1995;17:3–12.PubMedCrossRefGoogle Scholar
  45. 45.
    Ormel J, Koeter MW, van den Brink W, van de Willige G. Recognition, management, and course of anxiety and depression in general practice. Arch Gen Psychiatry. 1991;48:700–6.PubMedGoogle Scholar
  46. 46.
    US Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd ed. Baltimore, Md: Williams & Wilkins; 1996.Google Scholar
  47. 47.
    Canadian Task Force on the Periodic Health Examination. Canadian Guide to Clinical Preventive Health Care. Ottawa, Ont.: Canada Communication Group: 1994.Google Scholar

Copyright information

© Society of General Internal Medicine 1997

Authors and Affiliations

  • Mary A. Whooley
    • 1
    • 2
  • Andrew L. Avins
    • 1
    • 2
    • 3
  • Jeanne Miranda
    • 4
  • Warren S. Browner
    • 1
    • 2
    • 3
  1. 1.General Internal Medicine SectionSan Francisco Department of Veterans Affairs Medical CenterSan Francisco
  2. 2.Department of MedicineGeorgetown University School of MedicineWashington, DC
  3. 3.Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan Francisco
  4. 4.Department of PsychiatryGeorgetown University School of MedicineWashington, DC

Personalised recommendations