Objective
To explore the issue of diagnostic specificity for major depression in the primary care setting by examining the relative accuracy of 3 methods to detect major depression in primary care.
Design
Comparison of performance characteristics of 3 case-finding methods for depression (ie, the Center for Epidemiologic Studies^Depression scale [CES-D], unaided physician detection, and "augmented" physician detection by use of a case-finding instrument), with the standard criterion being the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R).
Setting
The offices of 50 family physicians from private and academic practice in southeastern Michigan.
Patients
Adult patients (N=1580) who presented for routine care, from which a weighted random sample of 425 patients completed the Structured Clinical Interview for DSM-III-R.
Main Outcome Measures
Sensitivity, specificity, positive predictive value, and positive likelihood ratio for each case-finding method.
Results
Major depression was present in 13.4% of the sample. Both the CES-D and unaided physician detection methods performed poorly in identifying patients who met DSM-III-R criteria for major depressive disorder. The CES-D had high sensitivity but low specificity at standard and high cut points, resulting, respectively, in low positive predictive values (0.307 and 0.385) and low positive likelihood ratios (2.9 and 4.0). Unaided physician detection showed lower sensitivity, higher specificity, and a slightly higher positive predictive value (0.45) and positive likelihood ratio (4.9). Raising of the CES-D threshold for a positive test did not enhance the detection of depression. Augmented physician detection with CES-D scores resulted in minimal improvement. Although the positive predictive value and positive likelihood ratio increased to 0.50 and 6.1, respectively, using the most stringent case-finding definition (ie, physician identification plus the CES-D score [score 
22]), the proportion of depressed patients who were correctly identified decreased to 26.9%.
Conclusions
Neither high scores on the CES-D nor unaided physician detection accurately identified patients with major depression who were seen in primary care settings, while the supplementation of physician detection with CES-D scores had a minimal net effect on the accuracy of detection. The data do not support the routine use of the CES-D as a primary care screening instrument for depression, either as a stand-alone measure or as a supplement to physician detection.
What Comprises Clinical Experience in Recognizing Depression?: The Primary Care Clinician's Perspective
Baik et al.
J Am Board Fam Med 2008;21:200-210.
ABSTRACT
| FULL TEXT
Factors Associated With Identification and Management of Maternal Depression by Pediatricians
Heneghan et al.
Pediatrics 2007;119:444-454.
ABSTRACT
| FULL TEXT
Definitions and Distinctions Among Depressive Syndromes and Symptoms: Implications for a Better Understanding of the Depression-Cardiovascular Disease Association
Davidson et al.
Psychosom. Med. 2005;67:S6-S9.
ABSTRACT
| FULL TEXT
The Recognition of Depression: The Primary Care Clinician's Perspective
Baik et al.
Ann Fam Med 2005;3:31-37.
ABSTRACT
| FULL TEXT
Predictors of Depression Three Months After Cardiac Hospitalization
Schrader et al.
Psychosom. Med. 2004;66:514-520.
ABSTRACT
| FULL TEXT
Is This Patient Clinically Depressed?
Williams et al.
JAMA 2002;287:1160-1170.
ABSTRACT
| FULL TEXT
A Prospective Study of Psychological Distress and Sexual Risk Behavior Among Black Adolescent Females
DiClemente et al.
Pediatrics 2001;108:e85-85.
ABSTRACT
| FULL TEXT
The Cost-Utility of Screening for Depression in Primary Care
Valenstein et al.
ANN INTERN MED 2001;134:345-360.
ABSTRACT
| FULL TEXT
False Positives, False Negatives, and the Validity of the Diagnosis of Major Depression in Primary Care
Klinkman et al.
Arch Fam Med 1998;7:451-461.
ABSTRACT
| FULL TEXT
