Use of brief psychiatric screening measures in a primary care sample

Abstract

Patients seen in primary medical clinics report higher rates of major depression [Pérez‐Stable et al., 1990: Arch Intern Med 15:1083–1088], and panic disorder [Sherbourne et al., 1996b: Von Korff et al., 1987: Arch Gen Psychiatry 44:152–156] than the general population. Primary care staff therefore need efficient methods of identifying patients with psychiatric disorders. The current study evaluates the use of several brief psychiatric screening measures for identifying patients with major depression and/or anxiety disorders. Participants were 213 primary care patients who received the Center for Epidemiological Studies Depression Scale (CES‐D), the Beck Anxiety Inventory (BAI), and two new instruments, the Autonomic Nervous System Questionnaire (ANS) for assessing panic disorder and the Social Phobia Questionnaire (SPQ) for assessing social phobia. Participants received both the screening instruments and a structured diagnostic interview. Results suggest that the CES‐D is a useful measure for detecting psychopathology, but it is not particularly specific to depression, the ANS was a highly sensitive and reasonably specific measure for panic disorder, and the SPQ was reasonably sensitive and specific for social phobia. The BAI was a relatively poor screening measure that added no significant information beyond the other measures. Depression and Anxiety 12:21–29, 2000. © 2000 Wiley‐Liss, Inc.

Assessment of depression in rheumatoid arthritis: A modified version of the center for epidemiologic studies depression scale

“…Prior research has indicated that the full scale CES-D is sensitive in identifying psychological distress, but may not be sensitive in identifying depression versus other types of psychological problems (e.g., bereavement, anxiety) (13,14). Results from this study indirectly support the notion that the CES-D may be more effective in identifying general psychological distress rather than depression specifically.…”

“…However, the sample sizes for the exploratory analyses in this article (n ϭ 160 in study 1 and n ϭ 344 in the supplemental analysis), where a majority of the subjects were assigned, were comparable to other studies that have examined the efficiency of a scale (n ϭ 213-425) (11,(13)(14)(15).…”

“…Research studies indicate that using CES-D cutoff scores generally results in adequate sensitivity (the degree to which actual depressed persons are identified based on the score), specificity (the degree to which actual nondepressed persons are identified based on the score), and negative predictive value (NPV; the proportion of individuals who are not depressed when the score identifies them as not depressed) (11,(13)(14)(15). In contrast, research indicates that CES-D cutoff scores often result in poor positive predictive value (PPV), which is defined as the proportion of individuals who are depressed when the score identifies them as depressed (11,(13)(14)(15).…”

“…In contrast, research indicates that CES-D cutoff scores often result in poor positive predictive value (PPV), which is defined as the proportion of individuals who are depressed when the score identifies them as depressed (11,(13)(14)(15). Thus, the commonly used CES-D cutoff scores often result in a high percentage of false positives, with numerous individuals being categorized as depressed who, in fact, do not meet the criteria for MDD.…”

Validation of clinical symptom IRT scores for diagnosis and severity assessment of common mental disorders

“…Its diagnostic ability was higher than the one reported in systematic reviews for PHQ-9 (Sensitivity = 0.77, CI 0.71-0.84; Specificity = 0.94) [47] or HDRS (Sensitivity = 0.76, Specificity = 0.91) [48]. Additionally, INS-D performed better than the 20-item Center for Epidemiological Studies Depression Scale (CES-D) (Sensitivity = 0.78; Specificity = 0.77) [49]. Nevertheless, this was to be expected as CES-D is an instrument created for screening purposes in epidemiological studies, and does not specifically address severity assessment and diagnosis.…”