Single-item Screening Question Research Articles

Are 2 Questions Enough to Screen for Depression and Anxiety in Patients With Chronic Low Back Pain?

Cross-sectional study. To examine the sensitivity of 2 single-item questions compared with 2 longer questionnaires for screening depression and anxiety among patients with chronic low back pain (CLBP). Psychosocial factors are frequently identified as risk factors for developing CLBP and as predictors for treatment, and questionnaires are often used to screen for this. Shorter instruments may be easier to use in clinical practice settings. A total of 564 patients with 2 to 10 months of at least 50% sickness absence due to nonspecific low back pain were assessed for depression and anxiety with the Mini-International Neuropsychiatric Interview (MINI). Single-item questions for depression and anxiety from the Subjective Health Complaint Inventory and 2 longer questionnaires, the Hospital Anxiety and Depression Scale and Hopkins Symptom Checklist-25, were compared with MINI results, considered the "gold standard" in this study. Sensitivity and specificity of single-item and longer questionnaires and receiver operating characteristic curves were compared. According to MINI, the prevalence of anxiety disorders was 12% whereas that of depressive disorders was 4%. The screening questions showed 95% sensitivity and 56% specificity for depressive disorders and 68% sensitivity and 85% specificity for anxiety disorders. The longer questionnaire, Hospital Anxiety and Depression Scale, showed 91% sensitivity and 85% specificity for depressive disorders and 58% sensitivity and 83% specificity for anxiety disorders. Hopkins Symptom Checklist-25 showed 86% sensitivity and 74% specificity for depressive disorders and 67% sensitivity and 87% specificity for anxiety disorders. For 3 of the anxiety disorders and 2 of the depressive disorders, a perfect sensitivity was found between the screening questions and MINI. A single-item screening question was sensitive for depression but less sensitive for anxiety. The screening questions further performed equal to 2 widely used questionnaires. Validation of these results in other populations and compared with other short-item screeners is needed.

Using the “Newest Vital Sign” to Assess Health Literacy in Children

IntroductionThe purpose of this study was to explore the feasibility, utility, and validity of using the Newest Vital Sign (NVS) tool to assess health literacy in children. MethodForty-seven parent-child dyads individually completed the NVS and a Home Literacy Environment single-item screening question (No. of children’s books in the home). ResultsThe majority (72%; n = 34) of parent-child dyads had adequate health literacy (NVS scores ≥4), with no significant differences (p = .95) between children’s NVS scores (M = 4.8, SD = 1.5) and parents (M = 4.8, SD = 1.6). A moderate, positive correlation was found between children’s and parents’ NVS scores (rs = .35, p = .017). Of note was that all of the parents (n = 4) and children (n = 6) who reported having only 10 or fewer children’s books in their homes had NVS scores less than 4, indicating inadequate health literacy. DiscussionThe NVS is a quick screening mechanism for identifying households that have adequate health literacy levels. Asking children the Home Literacy Environment single-question screening item (No. of children’s books) provided additional insight that confirmed and extended findings from the NVS.

Screening for At-Risk Alcohol Use and Drug Use in an Emergency Department: Integration of Screening Questions Into Electronic Triage Forms Achieves High Screening Rates

Previous studies have shown that brief interventions for at-risk alcohol and drug use are significantly more likely to occur if patients are screened with a standardized, validated instrument, but high screening rates have traditionally been difficult to attain. Use of very brief screens can enable brief intervention specialists to focus their efforts on assessing and assisting patients most likely to need a brief intervention or more intensive treatment. This study describes the results of integrating brief substance abuse screens into an urban emergency department's (ED's) triage process. As part of a comprehensive initiative to increase alcohol and drug screening, brief intervention, and referral to treatment (SBIRT), 3 single-item screening questions were programmed into the electronic triage tool used in the ED to detect tobacco use, at-risk alcohol use, illicit drug use, or prescription drug misuse. Project staff conducted training sessions with nurses to ensure the questions were asked properly and ED supervisors provided ongoing performance feedback. Names of patients with positive responses to the alcohol or drug questions automatically populated a list forwarded to health education specialists, who provided assessments, brief interventions, and referrals. Screening was conducted with 145,394 of 151,597 eligible patients, a 96% screening rate. Electronic reports revealed an 89% screening rate 30 days postimplementation and gradually increasing and stabilizing at approximately 97%. The overall percentage of patients screening positive for alcohol or drug use was similar to that of other ED-based studies (22%) but varied substantially by patient demographics. High rates of screening can be achieved if properly integrated into a clinical setting's existing patient care processes with well-planned information technology support.

An Assessment of the Screening Performance of a Single-Item Measure of Depression From the Edmonton Symptom Assessment Scale Among Chronically Ill Hospitalized Patients

ContextFew studies have examined the validity of using a single item from the Edmonton Symptom Assessment Scale (ESAS) for screening for depression. ObjectivesTo examine the screening performance of the single-item depression question from the ESAS in chronically ill hospitalized patients. MethodsA total of 162 chronically ill inpatients aged 65 and older completed a survey after admission that included the well-validated, 15-item Geriatric Depression Scale (GDS-15) and four single-item screening questions for depression based on the ESAS question, using two different time frames (“now” and “in the past 24 hours”) and two response categories (a 0–10 numeric rating scale [NRS] and a categorical scale: none, mild, moderate, and severe). ResultsThe GDS-15 categorized 20% (n=33) of participants as possibly being depressed with a score ≥6. The NRS for depression “now” achieved the highest level of sensitivity at a cutoff≥1 (68.8%), and an acceptable level of specificity was obtained at a cutoff of ≥5 (82.2%). For depression “in the past 24 hours,” a cutoff of ≥1 achieved a sensitivity of 68.8% and a cutoff of ≥7 a specificity of 80.3%. For the categorical scale, a cutoff of “none” provided the best level of sensitivity for depression “now” (65.6%) and “in the past 24 hours” (81.3%), with an acceptable level of specificity being obtained at ≥“mild” (68.8%) and ≥“moderate” (68.8%), respectively. ConclusionThese single-item measures were not effective in screening for probable depression in chronically ill patients regardless of the time frame or the response format used, but a cutoff of ≥5 or “mild” or greater did achieve sufficient specificity to raise clinical suspicion.

Suicidal Ideation and Perceived Burdensomeness in Patients with Chronic Pain

There is a clear relationship between suicide risk and chronic pain conditions. However, the exact nature of this link has been poorly understood, with risk attribution often limited to comorbid depression. Perceived burdensomeness has already been confirmed as a risk factor for suicidal ideation (SI) and suicide attempt in the general population. Self-perceived burden, studied among medically and terminally ill medical populations, has begun to receive a great deal of attention as a suicide risk factor. However, this risk has not been considered in an outpatient chronic pain population, a group likely to experience perceived burdensomeness as a particular problem. Guidelines recommend routine suicide risk screening in medical settings, but many questionnaires are time-consuming and do not allow for the assessment of the presence of newly identified risk constructs, such as perceived burdensomeness. This retrospective study examined the relationship between depression, perceived burdensomeness, and SI in a patient sample seeking behavioral treatment for chronic pain management. A logistic regression model was developed, with preliminary results indicating perceived burdensomeness was the sole predictor of SI, even in the presence of other well-established risk factors such as age, gender, depressive symptoms, and pain severity. Findings highlight the potential utility of a single-item screening question in routine clinical care as an incrementally superior predictor of SI in a chronic pain population.

How Valid Is a Single-Item Measure of Depression Among Seriously Ill Hospitalized Patients? (419-A)

1.Examine the effectiveness single-item measures to screen for depression.2.Compare two single-item measures to screen for depression in hospitalized patients. Background. Depression is a common psychiatric disorder that can impact symptom management and quality of life in seriously ill patients. Many instruments used to screen for depression among hospitalized elderly patients can be difficult to administer during physician consultations for a variety of reasons including time constraints. Research objectives. Examine the validity of a single-item measure to screen for depression among hospitalized elders with chronic illness. Methods. A total of 162 inpatients completed a survey after admission that included the well-validated, 15-item Geriatric Depression Scale (GDS-15) and two single-item screening questions for depression: a 0–10 numeric rating scale with 0 as not depressed and 10 being the worst depression you can imagine and a categorical scale: none, mild, moderate and severe. Results. The GDS-15 categorized 20% (n = 33) of participants as possibly being depressed. On the 11-point scale, 27% (n = 44) were categorized as possibly depressed and 15% (n = 25) using the categorical scale. The level of agreement between the numeric and categorical scale was high (r = 0.83), but when compared with the GDS-15 there was only a moderate correlation for the numeric (r = 0.37) and categorical scale (r = 0.37). The single item measures were able to accurately categorize 65% of patients as possibly depressed and 75% as not depressed. Conclusion. A single-item measure screening for depression did not correlate well with a longer, validated screening tool. Clinicians should be cautious when screening patients for depression using single item measures of depression. Implications for research, policy, or practice. Although single-item screens are efficient and attractive to clinicians and effective for assessing physical symptoms such as pain and dyspnea, such tools should not be used to screen for depression. The single-item question for depression may be assessing something important, but more research is needed to understand precisely what patient responses represent. Psychological and Psychiatric Aspects of Care

‘A no means no’—measuring depression using a single-item question versus Hospital Anxiety and Depression Scale (HADS-D)

BackgroundDepression often develops undetected; to make treatment possible, a single-item screening question may be useful. Patients and methodsWe attempted to compare the accuracy of the single-item question ‘Are you depressed?’ with the seven-item Depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) among 1192 Swedish testicular cancer survivors. ResultsWe obtained information from 974 men (82%). Fifty-nine men (6%) answered ‘Yes’ to the question ‘Are you depressed?’ while 118 (12%) answered ‘I don't know’ and 794 (82%) answered ‘No’. Among the 794 men who answered ‘No’ to the question ‘Are you depressed?’, 790 (99.5%) were not considered as depressed according to HADS-D 11+. Of those answering ‘Yes’, 34% (20/59) were identified as depressed according to the same cut-off. Sensitivity of ‘Yes’ compared with HADS-D ≥11 was 61%, rising to 88% when ‘Yes’ and ‘I don't know’ were combined. ConclusionIn a population of men with a prevalence of depression similar to that of the normal population, almost none of those responding ‘No’ to the written question ‘Are you depressed?’ were depressed according to HADS-D ≥11. Adding the category ‘I don't know’ increases sensitivity in detecting depression.

Health literacy and physical and psychological wellbeing in Japanese adults

Objective To determine the prevalence of low health literacy and investigate the relationship between low health literacy and physical and psychological wellbeing in the Japanese general population. Methods A web-based cross-sectional survey was conducted in a national sample of Japanese adults. Health literacy was measured by self-report using the validated single-item screening question, “How confident are you filling out forms by yourself?” Wellbeing was measured with the physical and psychological domains of the World Health Organization Quality of Life Assessment-BREF. Effect sizes were computed by dividing the mean difference in scores by the standard deviation of the scores of all participants. Results In 1040 adult enrollees (mean age, 57-year-old; women, 52%), there were 161 (15.5%; 95% confidence interval [CI], 13.3–17.7%) with low health literacy. Individuals with low health literacy reported lower physical wellbeing (60.6 vs. 71.7, p < 0.001) and psychological wellbeing (59.7 vs. 68.3, p < 0.001) compared with those with adequate health literacy. After adjusting for sociodemographic characteristics, health risk behaviors and chronic conditions, these differences were still significant (physical wellbeing, p < 0.001; psychological wellbeing, p < 0.001). The effect sizes of the difference of scores were moderate for physical wellbeing (−0.55) and also for psychological wellbeing (−0.44). Conclusion The prevalence of self-reported low health literacy in Japanese adults is substantial and it is independently associated with poorer physical and mental wellbeing. Practice implications Efforts to monitor health literacy and to evaluate causal pathways to poor wellbeing should be encouraged in the Japanese population.

Validity of children's reports of parental alcohol abuse.

Data from interviews with parents and 9-12 year old children from 303 families were used to test the validity of children's reports of parental alcoholism or problem drinking status. Children's responses to several single-item screening questions that had been used previously to identify children of alcoholics, as well as their responses to the Short Michigan Alcoholism Screening Test for each parent, were compared to parents' alcoholism diagnosis and screening test scores. In general, children's responses correctly identified only a small portion of alcoholic parents and, when all screening items were combined into a single screening tool to increase sensitivity, the false positive rate became unreasonable for most applications. The screening items were better at identifying active alcoholics than abstaining alcoholics but were also better at identifying problem drinking parents than alcoholic parents. None of the screening options tested had optimal characteristics for use in research or intervention applications.