The psychometric properties of depression screening tools in primary healthcare settings: A systematic review.

BACKGROUND Consensus on a tool for depression screening among adults in primary healthcare (PHC) settings is lacking. This systematic review aimed to explore the psychometric properties of depression screening tools. METHODS A systematic literature search composed of four terms (screening AND psychometric AND depression AND primary healthcare) was conducted in PubMed, EMBASE, PsycINFO and MEDLINE, between January 1995 through October 2015. Studies that aimed to psychometrically test a depression screening tool among the general adult population in a PHC setting were included. Studies exploring the diagnostic properties of depression screening tools among specific populations were excluded. RESULTS Sixty publications, evaluating the psychometric properties of 55 tools or adaptations, were included. Studies were conducted in 24 countries and 18 languages on 48234 adults. The Patient Health Questionnaire-9 was the most evaluated tool with 14 studies evaluating its psychometric properties. Fifty-four studies reported on at least one measure of receiver operating characteristics. Sensitivity and specificity values ranged from 28% to 100% and 43% to 100%, respectively. Cronbach alpha values ranged from 0.56 to 0.94. Other forms of reliability and validity testing were less consistently and commonly reported. LIMITATIONS The inclusion of studies regardless of methodological quality or design may have limited generalizability, but allowed for a comprehensive and detailed overview of the current literature. CONCLUSIONS Depression screening tools vary in their psychometric properties. The PHQ-9 was the most extensively psychometrically tested tool. This systematic review may aid PHC professionals in choosing a depression screening tool for universal use as it provides a comprehensive overview of their psychometric properties.

[1]  M. Fava,et al.  USE OF THE CHINESE VERSION OF THE BECK DEPRESSION INVENTORY FOR SCREENING DEPRESSION IN PRIMARY CARE , 2002, The Journal of nervous and mental disease.

[2]  A. Nierenberg,et al.  Screening for major depression in Asian‐Americans: a comparison of the Beck and the Chinese Depression Inventory , 2002, Acta psychiatrica Scandinavica.

[3]  C. Mulrow,et al.  Depressive Disorders in Primary Care " Prevalence , Functional Disability , and Identification , 2007 .

[4]  T. Okumura,et al.  Screening for Major Depressive Disorder with the Patient Health Questionnaire (PHQ-9 and PHQ-2) in an Outpatient Clinic Staffed by Primary Care Physicians in Japan: A Case Control Study , 2015, PloS one.

[5]  Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients. , 2001 .

[6]  D. Henderson,et al.  Screening for PTSD and depression in Bosnia and Herzegovina: validating the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist , 2008 .

[7]  M. Weissman,et al.  Brief screens for mental disorders in primary care , 1996, Journal of General Internal Medicine.

[8]  M. Stein,et al.  Use of brief psychiatric screening measures in a primary care sample , 2000, Depression and anxiety.

[9]  M. Barkham,et al.  Diagnosing depression in primary care using self-completed instruments: UK validation of PHQ-9 and CORE-OM. , 2007, The British journal of general practice : the journal of the Royal College of General Practitioners.

[10]  M. Lee,et al.  Screening of depression in patients with chronic medical diseases in a primary care setting. , 1998, Family practice.

[11]  H. Möller,et al.  Screening for depression in primary care: Will one or two items suffice? , 2004, European Archives of Psychiatry and Clinical Neuroscience.

[12]  R. Sanson-Fisher,et al.  Comparison of a single self-assessment item with the PHQ-9 for detecting depression in general practice. , 2014, Family practice.

[13]  R. Spitzer,et al.  The PHQ-9 , 2001, Journal of General Internal Medicine.

[14]  H. Möller,et al.  Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition , 2007, Depression and anxiety.

[15]  J. Coyne,et al.  Can case-finding instruments be used to improve physician detection of depression in primary care? , 1997, Archives of family medicine.

[16]  M. Prince,et al.  Validity of brief screening questionnaires to detect depression in primary care in Ethiopia. , 2015, Journal of affective disorders.

[17]  M. Harrington,et al.  Screening for Perinatal Depression With Limited Psychiatric Resources , 2005 .

[18]  J. Ormel,et al.  A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects , 1997, Psychological Medicine.

[19]  R. Spitzer,et al.  The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener , 2003, Medical care.

[20]  A. Beck,et al.  Use of the Beck Anxiety and Depression Inventories for Primary Care with Medical Outpatients , 1997, Assessment.

[21]  D. Rice,et al.  Risk of Bias from Inclusion of Currently Diagnosed or Treated Patients in Studies of Depression Screening Tool Accuracy: A Cross-Sectional Analysis of Recently Published Primary Studies and Meta-Analyses , 2016, PloS one.

[22]  M. Lotrakul,et al.  Reliability and validity of the Thai version of the WHO‐Five Well‐Being Index in primary care patients , 2009, Psychiatry and clinical neurosciences.

[23]  T. Furukawa,et al.  Validity of the Patient Health Questionnaire (PHQ)-9 and PHQ-2 in general internal medicine primary care at a Japanese rural hospital: a cross-sectional study. , 2013, General hospital psychiatry.

[24]  C. Tse,et al.  Anxiety and depressive symptom identification using the Duke Health Profile. , 1996, Journal of clinical epidemiology.

[25]  I. Nazareth,et al.  The Patient Health Questionnaire-9 for detection of major depressive disorder in primary care: consequences of current thresholds in a crosssectional study , 2010, BMC family practice.

[26]  H. Möller,et al.  Use of brief depression screening tools in primary care: consideration of heterogeneity in performance in different patient groups. , 2004, General hospital psychiatry.

[27]  E. Nickel,et al.  Minor versus major depression: a comparative clinical study. , 2010, Primary care companion to the Journal of clinical psychiatry.

[28]  M. Olfson,et al.  Diagnostic Errors of Primary Care Screens for Depression and Panic Disorder , 1999, International journal of psychiatry in medicine.

[29]  R. Nagel,et al.  Validity of the medical outcomes study depression screener in family practice training centers and community settings. , 1998, Family medicine.

[30]  O. Gureje,et al.  Validation of short screening tools for common mental disorders in Nigerian general practices. , 2014, General hospital psychiatry.

[31]  R. Spitzer,et al.  Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. , 1999, JAMA.

[32]  Diagnostic Accuracy of the Primary Care Screener for Affective Disorder (PC-SAD) in Primary Care , 2013, Clinical practice and epidemiology in mental health : CP & EMH.

[33]  C. Arfken,et al.  Confirmatory factor analysis of the Portuguese Depression Anxiety Stress Scales-21. , 2012, Revista latino-americana de enfermagem.

[34]  M. Lotrakul,et al.  Reliability and validity of the Thai version of the PHQ-9 , 2008, BMC psychiatry.

[35]  M. Fava,et al.  Validation of the Patient Health Questionnaire-9 for depression screening among Chinese Americans. , 2008, Comprehensive psychiatry.

[36]  Randolph C. Arnau,et al.  An Efficient Method of Identifying Major Depression and Panic Disorder in Primary Care , 2005, Journal of Behavioral Medicine.

[37]  C. Terwee,et al.  The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study , 2010, Quality of Life Research.

[38]  H. Ågren,et al.  Detection of major depression in Ugandan primary health care settings using simple questions from a subjective well-being (SWB) subscale , 2007, Social psychiatry and psychiatric epidemiology.

[39]  Blair T. Johnson,et al.  Rethinking recommendations for screening for depression in primary care , 2012, Canadian Medical Association Journal.

[40]  C. Mulrow,et al.  Case-finding for depression in primary care: a randomized trial. , 1999, The American journal of medicine.

[41]  N. Amodei,et al.  Psychometric Assessment of Measures of Psychological Symptoms, Functional Status, Life Events, and Context for Low Income Hispanic Patients in a Primary Care Setting , 2002, Psychological reports.

[42]  Ann Vander Stoep,et al.  Validity of the patient health questionnaire-9 for depression screening and diagnosis in East Africa , 2013, Psychiatry Research.

[43]  A. Feinstein,et al.  A Screening Instrument for Psychological Distress in Botswana: Validation of the Setswana Version of the 28-Item General Health Questionnaire , 2009, The International journal of social psychiatry.

[44]  Jeannette Milgrom,et al.  Screening for perinatal depression. , 2014, Best practice & research. Clinical obstetrics & gynaecology.

[45]  M. Olfson,et al.  Development and validation of the SDDS-PC screen for multiple mental disorders in primary care. , 1995, Archives of family medicine.

[46]  M. Tansella,et al.  The Personal Health Questionnaire: a new screening instrument for detection of ICD-10 depressive disorders in primary care , 2000, Psychological Medicine.

[47]  W. Chin,et al.  The Psychometric Properties of the Center for Epidemiologic Studies Depression Scale in Chinese Primary Care Patients: Factor Structure, Construct Validity, Reliability, Sensitivity and Responsiveness , 2015, PloS one.

[48]  Y. Conwell,et al.  Validation of the nine‐item Patient Health Questionnaire to screen for major depression in a Chinese primary care population , 2013, Asia-Pacific psychiatry : official journal of the Pacific Rim College of Psychiatrists.

[49]  T. Chen,et al.  A feasibility study of community pharmacists performing depression screening services. , 2015, Research in social & administrative pharmacy : RSAP.

[50]  The English version of the four-dimensional symptom questionnaire (4DSQ) measures the same as the original Dutch questionnaire: A validation study , 2014, The European journal of general practice.

[51]  A. Leon,et al.  An evaluation of a computer assisted telephone interview for screening for mental disorders among primary care patients. , 1999, The Journal of nervous and mental disease.

[52]  L. Loutan,et al.  Transcultural Validity of a Structured Diagnostic Interview to Screen for Major Depression and Posttraumatic Stress Disorder Among Refugees , 2007, The Journal of nervous and mental disease.

[53]  M. Stein,et al.  Abbreviated brief symptom inventory for use as an anxiety and depression screening instrument in primary care , 2008, Depression and anxiety.

[54]  D. Mori,et al.  The BAI–PC as a Screen for Anxiety, Depression, and PTSD in Primary Care , 2003, Journal of Clinical Psychology in Medical Settings.

[55]  L. Frostholm,et al.  A brief case-finding questionnaire for common mental disorders: the CMDQ. , 2005, Family practice.

[56]  H A Pincus,et al.  ‘Subthreshold’ mental disorders , 1999, British Journal of Psychiatry.

[57]  P. Brantley,et al.  Use of the Beck Depression Inventory-II with African American primary care patients. , 2004, General hospital psychiatry.

[58]  T. Kramer,et al.  The Depression-Arkansas scale: A validation study of a new brief depression scale in an HMO. , 2003, Journal of clinical psychology.

[59]  Evaluating the validity of the French version of the Four-Dimensional Symptom Questionnaire with differential item functioning analysis. , 2015, Family practice.

[60]  Zai-Ting Yeh,et al.  Validation of Patient Health Questionnaire for depression screening among primary care patients in Taiwan. , 2011, Comprehensive psychiatry.

[61]  M. M. Shah,et al.  Validation of the Malay Version Brief Patient Health Questionnaire (PHQ-9) among Adult Attending Family Medicine Clinics. , 2005 .

[62]  Y. Chan,et al.  Screening for major and minor depression in a multiethnic sample of Asian primary care patients: A comparison of the nine‐item Patient Health Questionnaire (PHQ‐9) and the 16‐item Quick Inventory of Depressive Symptomatology – Self‐Report (QIDS‐SR16) , 2013, Asia-Pacific psychiatry : official journal of the Pacific Rim College of Psychiatrists.

[63]  P. Areán,et al.  The utility of the Center for Epidemiological Studies-Depression Scale in older primary care patients , 1997 .

[64]  T. Sheldon,et al.  Screening and case finding instruments for depression. , 2005, The Cochrane database of systematic reviews.

[65]  W. Broadhead,et al.  Screening for anxiety and depression in primary care with the Duke Anxiety-Depression Scale. , 1997, Family medicine.

[66]  M. Phipps,et al.  Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. , 2016, JAMA.

[67]  Bradley N Gaynes,et al.  Feasibility and Diagnostic Validity of the M-3 Checklist: A Brief, Self-Rated Screen for Depressive, Bipolar, Anxiety, and Post-Traumatic Stress Disorders in Primary Care , 2010, The Annals of Family Medicine.

[68]  N. Husain,et al.  The validation of personal health questionnaire amongst people of Pakistani family origin living in the United Kingdom. , 2007, Journal of affective disorders.

[69]  M. Phipps,et al.  Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement. , 2016, JAMA.

[70]  W. Browner,et al.  Case-finding instruments for depression , 1997, Journal of General Internal Medicine.