The use of a Two-Question depression screen for the detection of depression in older emergency department patients

Abstract

Study objectives: We determine the sensitivity and specificity of a brief 2-question depression screen for the detection of depression in older emergency department (ED) patients. Methods: This was a prospective, observational study. Participants were a convenience sampling of ED patients 70 years and older presenting to an urban teaching hospital over a 17-month period. Exclusions included refusal, inability to communicate, and critical illness. Patients were screened for depression with the previously validated short-form geriatric depression scale (SFGDS). Standardized scores on the SFGDS were used to determine the prevalence of depression. Patients were then evaluated using a previously published 2-question depression screen, and results were compared to the SFGDS as criterion standard. Sensitivity and specificity of the 2-question screen are reported as proportions with 95% confidence intervals (CIs). Results: Two hundred sixty-seven of 327 eligible patients were enrolled. Forty-four (17%; 95% CI 12% to 21%) patients scored positive for depression on the SFGDS. The sensitivity of the brief depression screen for the detection of depression was 84% (37/44; 95% CI 70% to 93%), with a specificity of 30% (37/124; 95% CI 22% to 38%) using a cutoff score of at least 1 of 2 positive responses; and 46% (20/44; 95% CI 30% to 61%), with a specificity of 41% (20/49; 95% CI 27% to 56%) using a cutoff score of 2 of 2 positive responses. Conclusion: In contrast to what has been previously reported, this brief 2-question depression screen has fair sensitivity and poor specificity for the detection of depression in older ED patients. Study objectives: We determine the sensitivity and specificity of a brief 2-question depression screen for the detection of depression in older emergency department (ED) patients. Methods: This was a prospective, observational study. Participants were a convenience sampling of ED patients 70 years and older presenting to an urban teaching hospital over a 17-month period. Exclusions included refusal, inability to communicate, and critical illness. Patients were screened for depression with the previously validated short-form geriatric depression scale (SFGDS). Standardized scores on the SFGDS were used to determine the prevalence of depression. Patients were then evaluated using a previously published 2-question depression screen, and results were compared to the SFGDS as criterion standard. Sensitivity and specificity of the 2-question screen are reported as proportions with 95% confidence intervals (CIs). Results: Two hundred sixty-seven of 327 eligible patients were enrolled. Forty-four (17%; 95% CI 12% to 21%) patients scored positive for depression on the SFGDS. The sensitivity of the brief depression screen for the detection of depression was 84% (37/44; 95% CI 70% to 93%), with a specificity of 30% (37/124; 95% CI 22% to 38%) using a cutoff score of at least 1 of 2 positive responses; and 46% (20/44; 95% CI 30% to 61%), with a specificity of 41% (20/49; 95% CI 27% to 56%) using a cutoff score of 2 of 2 positive responses. Conclusion: In contrast to what has been previously reported, this brief 2-question depression screen has fair sensitivity and poor specificity for the detection of depression in older ED patients.