Elsevier

Behavior Therapy

Volume 41, Issue 3, September 2010, Pages 423-431
Behavior Therapy

Using the QIDS-SR16 to Identify Major Depressive Disorder in Primary Care Medical Patients

https://doi.org/10.1016/j.beth.2009.12.002Get rights and content

Abstract

Major depressive disorder (MDD) is a serious and prevalent mental health issue. As the majority of MDD cases are identified and treated by one's primary care physician, it is imperative that care providers utilize accurate and efficient methods for diagnosing MDD in primary care settings. The present study is the first to investigate the accuracy of the Quick Inventory of Depressive Symptomatology–Self Report (QIDS-SR16) as a screen for MDD. A heterogeneous sample of 155 primary care patients completed the QIDS-SR16 prior to attending a primary care appointment. Participants were then assessed for psychopathology using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) by clinicians who were blind to QIDS-SR16 scores. Scores on the QIDS-SR16 were compared to clinician-assessed current and lifetime diagnoses derived from the SCID, which represented the gold-standard criterion measure. Receiver operator characteristic analysis was utilized to determine the optimal QIDS-SR16 cut score to correctly classify participants based on their MDD status as assessed by the SCID. The test revealed a robust area under the curve (.82, p < 0.00001) and suggested that a cut score of 13 or 14 provided the best balance of sensitivity (76.5%) and specificity (81.8%) in this primary care sample. Over 80% of participants were correctly classified. Separate analyses by race were conducted to address the possibility that different cut scores may be more accurate for African American and Caucasians. Findings from the present study provide support for the use of the QIDS-SR16 as a screening measure for identifying primary care patients who will meet diagnostic criteria for MDD based on clinician assessment.

Section snippets

Participants

Participants were 155 patients (123 females) at an urban, public hospital family medical center serving a lower-income population in a midsized midwestern U.S. city. Participants were considered eligible if they were over 18 years of age at the time of interview. The mean age of participants was 39 years (SD = 14.18), ranging from 18 to 79 years of age. A similar number of participants self-identified as either Caucasian (74; 47.7%) or African American (68; 43.9%), with the remaining (13; 8.39%)

Diagnostic Prevalences

The mean QIDS-SR16 score for this sample was 10 (SD = 6), indicating a mild to moderate level of depressive symptoms. Based on the recommended thresholds to estimate depression severity (Rush et al., 2003), 41 participants (26.5%) endorsed no depression, 50 participants (32.3%) endorsed mild depression, 32 participants (20.6%) endorsed moderate depression, 24 participants (15.5%) endorsed severe depression, and 8 participants (5.2%) endorsed very severe depression. Based on the SCID, 34 (21.9%)

Discussion

Findings from the present study provide initial support for the use of the QIDS-SR16 as a screening measure for identifying individuals who meet diagnostic criteria for MDD based on clinician assessment. Using a cut score of 13 or 14 on the QIDS-SR16, either of which optimized both the sensitivity and specificity of the measure, over 80% of participants were correctly classified with regards to MDD status. This level of prediction is significantly better than chance. Importantly, 22 (18.2%) of

Acknowledgement

Support for this research was provided to David M. Fresco by the Ohio Board of Regents.

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