PURPOSE Although screening for unipolar depression is controversial, it is potentially an effi cient way to fi nd undetected cases and improve diagnostic acumen. Using a reference standard, we aimed to validate the 2-and 9-question Patient Health Questionnaires (PHQ-2 and PHQ-9) in primary care settings. The PHQ-2 comprises the fi rst 2 questions of the PHQ-9. METHODSConsecutive adult patients attending Auckland family practices completed the PHQ-9, after which they completed the Composite International Diagnostic Interview (CIDI) depression reference standard. Sensitivities and specifi cities for PHQ-2 and PHQ-9 were analyzed. RESULTS There were 2,642 patients who completed both the PHQ-9 and the CIDI. Sensitivity and specifi city of the PHQ-2 for diagnosing major depression were 86% and 78%, respectively, with a score of 2 or higher and 61% and 92% with a score 3 or higher; for the PHQ-9, they were 74% and 91%, respectively, with a score of 10 or higher. For the PHQ-2 a score of 2 or higher detected more cases of depression than a score of 3 or higher. For the PHQ-9 a score of 10 or higher detected more cases of major depression than the PHQ determination of major depression originally described by Spitzer et al in 1999.CONCLUSIONS We report the largest validation study of the PHQ-2 and PHQ-9, compared with a reference standard interview, undertaken in an exclusively primary care population. The PHQ-2 score or 2 or higher had good sensitivity but poor specifi city in detecting major depression. Using a PHQ-2 threshold score of 2 or higher rather than 3 or higher resulted in more depressed patients being correctly identifi ed. A PHQ-9 score of 10 or higher appears to detect more depressed patients than the originally described PHQ-9 scoring for major depression.

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For the past 20 years, the New Zealand Deprivation Index (NZDep) has been the universal measure of area-based social circumstances for New Zealand (NZ) and often the key social determinant used in population health and social research. This paper presents the first theoretical and methodological shift in the measurement of area deprivation in New Zealand since the 1990s and describes the development of the New Zealand Index of Multiple Deprivation (IMD).We briefly describe the development of Data Zones, an intermediary geographical scale, before outlining the development of the New Zealand Index of Multiple Deprivation (IMD), which uses routine datasets and methods comparable to current international deprivation indices. We identified 28 indicators of deprivation from national health, social development, taxation, education, police databases, geospatial data providers and the 2013 Census, all of which represented seven Domains of deprivation: Employment; Income; Crime; Housing; Health; Education; and Geographical Access. The IMD is the combination of these seven Domains. The Domains may be used individually or in combination, to explore the geography of deprivation and its association with a given health or social outcome.Geographic variations in the distribution of the IMD and its Domains were found among the District Health Boards in NZ, suggesting that factors underpinning overall deprivation are inconsistent across the country. With the exception of the Access Domain, the IMD and its Domains were statistically and moderately-to-strongly associated with both smoking rates and household poverty.The IMD provides a more nuanced view of area deprivation circumstances in Aotearoa NZ. Our vision is for the IMD and the Data Zones to be widely used to inform research, policy and resource allocation projects, providing a better measurement of area deprivation in NZ, improved outcomes for Māori, and a more consistent approach to reporting and monitoring the social climate of NZ.