Skip to Main Content
The Rational Clinical Examination: Evidence-Based Clinical Diagnosis

Depression

Make the Diagnosis: Depression

Prior Probability

Although most depression screening focuses on major depressive disorders, a number of treatable conditions may be detected by depression screening. In primary care, the combined prevalence of depression and dysthymia is approximately 7% to 12% (Table 19-7).

Table 19-7Prevalence of Depression and Dysthymia in Primary Care
View Table||Download (.pdf)
Table 19-7 Prevalence of Depression and Dysthymia in Primary Care
Illness Prevalence, %
Major depressive disorder 4.8-8.6
Dysthymic disorder 2.1-3.7
Depression NOS 4.4-5.4

Abbreviation: NOS, not otherwise specified.

Populations for Whom Depression Should Be Assessed

All adults.

Detecting the Likelihood of Major Depressive Disorder or Dysthymia

See Table 19-8.

Table 19-8Likelihood Ratios for Detecting Major Depressive Disorder
View Table||Download (.pdf)
Table 19-8 Likelihood Ratios for Detecting Major Depressive Disorder
Instrument and Threshold Summary LR+ (95% CI) or Range Summary LR– (95% CI) or Range
PHQ-9 (score ≥ 10 is positive)a 4.9-7.3 0.02-0.14
PRIME-MD (score ≥ 1 is positive) 2.6 (2.1-3.2) 0.15 (0.08-0.28)

Abbreviations: CI, confidence interval; LR+, positive likelihood ratio; LR–, negative likelihood ratio; PHQ-9, 9-item Patient Health Questionnaire; PRIME-MD, Primary Care Evaluation of Mental Disorders.

aData are the range of values across studies; summary statistics were not calculated because 2 thresholds (10 and 11) were used.

Detecting the Likelihood of Major Depressive Disorder

See Table 19-9.

Table 19-9Likelihood Ratios for Detecting Major Depressive Disorder or Dysthymia
View Table||Download (.pdf)
Table 19-9 Likelihood Ratios for Detecting Major Depressive Disorder or Dysthymia
Instrument Summary LR+ (95% CI) Summary LR– (95% CI)
PHQ-9 (score ≥ 10 is positive) 5.9 (4.2-8.3) 0.29 (0.23-0.38)

Abbreviations: CI, confidence interval; LR+, positive likelihood ratio; LR–, negative likelihood ratio; PHQ-9, 9-item Patient Health Questionnaire.

Reference Standard Tests

A structured (eg, Diagnostic Interview Schedule) or semistructured diagnostic interview (eg, Structured Clinical Interview for DSM-IV) to establish diagnoses.

Original Article: Is This Patient Clinically Depressed?

Clinical Scenario

Mr P is a 52-year-old small-business owner with a 5-year history of controlled hypertension, for which he takes a thiazide diuretic. Otherwise, he is in good health. He presents for routine follow-up and notes a 1-month history of mild to moderate bitemporal headaches and feeling fatigued. The headaches occur about twice a week and are relieved by acetaminophen. He denies chest pain or dyspnea on exertion. He notes wryly that the “new economy” has left him feeling a bit “frazzled.”

You wonder whether the headache and fatigue are stress related, a somatic presentation of depression. What is the most effective ...

Related Content
Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed › Chapter 16: The Process of Diagnosis
Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed › Chapter 17: Differential Diagnosis
Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed › Chapter 18: Diagnostic Tests

Education Guide

Depression
View All

Learning Tools

Critical Appraisal Worksheets
Diagnostic Tests
Differential Diagnosis
Information Cycle Worksheets
Diagnostic Tests
Differential Diagnosis
View All

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MHE Privacy Center Close