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

doi:10.1136/bmj.38607.464537.7C

BMJ 2005;331:884 (15 October), doi:10.1136/bmj.38607.464537.7C (published 15 September 2005)

Primary care

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

B Arroll, professor¹, F Goodyear-Smith, senior lecturer¹, N Kerse, associate professor¹, T Fishman, senior lecturer¹, J Gunn, associate professor²

¹ Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Private Bag 92019, Auckland, New Zealand, ² Department of General Practice University of Melbourne, Australia

Correspondence to: B Arroll b.arroll{at}auckland.ac.nz

Objective To determine the validity of two written screeningquestions for depression with the addition of a question inquiringif help is needed.

Design Cross sectional validation study.

Setting 19 general practitioners in six clinics in New Zealand.

Participants 1025 consecutive patients receiving no psychotropicdrugs.

Main outcome measures Sensitivity, specificity, and likelihoodratios of the two screening questions, the help question, combinationsof the screening and help questions, and diagnosis by generalpractitioners.

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 questionwas 13.0 (9.5 to 17.8) and the negative likelihood ratio was0.27 (0.17 to 0.44). The likelihood ratio for patients wantinghelp today was 17.5 (11.8 to 31.9). The general practitionerdiagnosis had a sensitivity of 79% (65% to 88%) and a specificityof 94% (92% to 95%).

Conclusion Adding a question inquiring if help is needed tothe two screening questions for depression improves the specificityof a general practitioner diagnosis of depression.

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