Evaluation of a 2-Question Screening Tool for Detecting Depression in Adolescents in Primary Care

Abstract

Eighty-five adolescents (ages 13 to 17), recruited from various metropolitan pediatric outpatient clinics, were administered the Patient Health Questionnaire (PHQ)-2, a two-item depression screener, along with two other well-established measures of depression, the Children’s Depression Inventory (CDI) and the Beck Depression Inventory (BDI). Results indicated a significant relationship between the second question of the PHQ-2 and the two established measures of depression. Discriminant function analysis revealed that classification of adolescents as depressed or not depressed on the basis of their responses to this second question resulted in correct classification of 73% of adolescents with a sensitivity of 0.48 and specificity of 0.60. The use of both questions resulted in lower classification accuracy (67%) but a higher sensitivity of 0.85 and a slightly lower specificity of 0.51 than either question alone. These results support the use of this measure as a brief screener for adolescent depression in primary care.

Keywords

depression adolescents screening primary care

Get full access to this article

View all access options for this article.

References

Committee on Psychosocial Aspects of Child and Family Health and Task Force on Mental Health. Policy statement- the future of pediatrics: mental health competencies for pediatric primary care. Pediatrics. 2009;124:410-421.

Birmaher B. , Ryan ND , Williamson DE , et al. Childhood and adolescent depression: a review of the past 10 years. Part I. J Am Acad Child Adolesc Psychiatry. 1996;35;1427-1439.

Birmaher B. , Ryan ND , Williamson DE , et al. Childhood and adolescent depression: a review of the past 10 years. Part II. J Am Acad Child Adolesc Psychiatry. 1996;35:1575-1583.

Lewinsohn PM , Hops H. , Roberts RE , Seeley JR , Andrews JA (1993) Adolescent psychopathology 1: prevalence and incidence of depression and other DSM-III-R disorders in high school students. Journal of Abnorm Psychol. 1993;102:133-144.

Kessler RC , Walters EE Epidemiology of DSM-III-R major depression and minor depression among adolescents and young adults in the national comorbidity survey. Depress Anxiety. 1998;7:3-14.

Zalsman G. , Brent DA , Weersing VR Depressive disorders in childhood and adolescence: an overview: epidemiology, clinical manifestation and risk factors. Child Adolesc Psychiatr Clin N Am. 2006;15:827-841.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision . Washington, DC: American Psychiatric Association; 2000.

Weissman MM , Wolk S. , Goldstein RB , et al. Depressed adolescents grown up. JAMA. 1999;281:1707-1713.

Birmaher B. , Bridge JA , Williamson DE , et al. Psychosocial functioning in youth at high risk to develop major depressive disorder. J Am Acad Child Adolesc Psychiatry. 2004;43:839-846.

10.

Kandel DB , Davies M. High school students who use crack and other drugs. Arch Gen Psychiatry. 1996;53:71-80.

11.

Gotlib IH , Lewinsohn PM , Seeley JR Symptoms versus a diagnosis of depression: difference in psychosocial functioning . J Consult Clin Psychol. 1995;63:90-100.

12.

Kandel DE , Raveis VH , Davies M. Suicidal ideation in adolescence: depression, substance use and other risk factors. J Youth Adolesc. 1991;20:289-309.

13.

Kubik MY , Lytle LA , Birnbaum AS , Murray DM , Perry CL Prevalence and correlates of depressive symptoms in young adolescents. Am J Health Behav. 2003;27:546-553.

14.

Pine DS , Cohen E. , Cohen P. , Brook J. Adolescent depressive symptoms as predictors of adult depression: moodiness or mood disorder? Am J Psychiatry. 1999;156:133-135.

15.

Fergusson DM , Horwood LJ , Ridder EM , Beuatrais AL Subthreshold depression in adolescence and mental health outcome in adulthood. Arch Gen Psychiatry. 2005;62: 66-72.

16.

Roberts RE , Roberts CR , Chen YR Ethnocultural differences in prevalence of adolescent depression. Am J Community Psychol. 1997;25:95-110.

17.

Shaikh IA , Shaikh MA Correlates of depression in the United States. Ann Epidemiol . 2004;14:603-603.

18.

Goodman E. , Slap GB , Huang B. The public health impact of socioeconomic status on adolescent depression and obesity. Am J Public Health. 2003;93:1844-1850.

19.

Weiller E. , Bisserbe JC , Maier W. , Lecrubier Y. Prevalence and recognition of anxiety syndromes in five European primary care settings: A report from the WHO Study on Psychological Problems in General Health Care. Br J Psychiatry. 1998;173(Suppl 34):18-23.

20.

Brown C. , Schulberg HC Diagnosis and treatment of depression in primary medical care practice: the application of research findings to clinical practice. J Clin Psychol. 1998;54:303-314.

21.

Katon W. , Schulberg H. Epidemiology of depression in primary care. Gen Hosp Psychiatry . 1992;14:237-247.

22.

Kessler D. , Bennewith O. , Lewis G. , Sharp D. Detection of depression and anxiety in primary care: follow-up study. BMJ. 2002;325:1016-1017.

23.

Pignone MP , Gaynes BN , Rushton JL , et al. Screening for depression in adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med . 2002;136:765-776.

24.

Coyle JT , Pine DS , Charney DS , et al; Depression and Bipolar Support Alliance Consensus Development Panel. Depression and bipolar support alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2003;42:1494-1503.

25.

Gilbody S. , Sheldon T. , Wessely S. Should we screen for Depression? BMJ. 2006 ;332:1027-1030.

26.

Arroll B. , Khin N. , Kerse N. Screening for depression in primary care with two verbally asked questions: cross-sectional study. BMJ. 2003;327:1144-1146.

27.

Kroenke K. , Spitzer RL , Williams JB The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606-613.

28.

Sielk M. , Altiner A. , Janssen B. , et al. Prevalence and diagnosis of depression in primary care. A critical comparison between PHQ-9 and GPs’ judgement [in German]. Psychiatr Praxis. 2009;36:169-174.

29.

DeJesus RS , Vickers KS , Melin GJ , Williams MD A system-based approach to depression management in primary care using the Patient Health Questionnaire. Mayo Clin Proc. 2007;82:1395-1402.

30.

Cannon DS , Tiffany ST , Coon H. , et al. The PHQ-9 as a brief assessment of lifetime major depression . Psychol Assess. 2007;19:247-251.

31.

Grothe KB , Dutton GR , Jones GN , Bodenlos J. , Ancona M. , Brantley PJ Validation of the Beck Depression Inventory-II in a low-income African American sample of medical outpatients. Psychol Assess. 2005;17:110-114.

32.

Kovacs M. Children’s Depression Inventory (CDI) Manual. North Tonawanda, NY: Multi-Health Systems; 1992.

33.

Lobovits DA , Hendal PJ Childhood depression: prevalence using DSM-III criteria and validity of parent and child depression scales. J Pediatr Psychol. 1985;10:45-54.

34.

Kovacs M. Children’s Depression Inventory (CDI). In Rush AJ Jr, First MB , Blacker D , eds. Handbook of Psychiatric Measures . Washington, DC: American Psychiatric Association; 2005.

35.

Beck AT The Beck Depression Inventory Manual. San Antonio, TX: Harcourt Brace Jovanovich; 1987.

36.

Beck AT , Steer RA Beck Depression Inventory (BDI). In Rush AJ Jr, First MB , Blacker D , eds. Handbook of Psychiatric Measures . Washington, DC: American Psychiatric Association; 2005.