Identifying patients with depression in the primary care setting: A more efficient method

David S. Brody, Steven R. Hahn, Robert L. Spitzer, Kurt Kroenke, Mark Linzer, Frank V. DeGruy, Janet B.W. Williams

Research output: Contribution to journalArticle

92 Scopus citations


Objective: To determine if there is a core subset of depressive symptoms that could be used to efficiently diagnose depression after administering the 2-item PRIME-MD a screening questionnaire for depression. Methods: One thousand patients selected randomly and by convenience from 4 primary care clinics were assessed by PRIME-MD and completed a questionnaire measuring the following validation variables: functional status and well-being, disability days, somatic symptoms, depression severity, suicidal thoughts, health care utilization, and the physician-patient relationship. Results: Four symptoms (sleep disturbance, anhedonia, low self-esteem, and decreased appetite) accounted for virtually all the depression symptom-related variance in functional status and well-being, with 8.3% of patients having 2 of these symptoms and 8.2% having 3 or 4 of these symptoms. There was excellent agreement between diagnosis based on core symptoms and major depression (κ = 0.77; overall accuracy rate, 94%). There were significant differences (P<.001) among patients with negative depression screen, 0 to 1, 2, and 3 to 4 core symptoms with scores on each of the validation variables getting progressively worse in these 4 groups. A cutoff point of 2 core symptoms identified all but 3 patients with major depression and an additional 5% of the entire sample without major depression who were significantly (P<.05) worse than patients without depression on each of the validation variables. Conclusion: A strategy that includes the use of a 2-item depression screener followed by the evaluation of 4 core depressive symptoms is an efficient and effective way of identifying and classifying primary care patients with depression in need of clinical attention.

Original languageEnglish (US)
Pages (from-to)2469-2475
Number of pages7
JournalArchives of Internal Medicine
Issue number22
StatePublished - Dec 7 1998

ASJC Scopus subject areas

  • Internal Medicine

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    Brody, D. S., Hahn, S. R., Spitzer, R. L., Kroenke, K., Linzer, M., DeGruy, F. V., & Williams, J. B. W. (1998). Identifying patients with depression in the primary care setting: A more efficient method. Archives of Internal Medicine, 158(22), 2469-2475.