Sensitivity and specificity of a two-question screening tool for depression in a specialist palliative care unit

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Abstract
Objectives: The primary objective in this study is to determine the sensitivity and specificity of a two-item screening interview for depression versus the formal psychiatric interview, in the setting of a specialist palliative in-patient unit so that we may identify those individuals suffering from depressive disorder and therefore optimise their management in this often-complex population. Methods: A prospective sample of consecutive admissions ( n = 167) consented to partake in the study, and the screening interview was asked separately to the formal psychiatric interview. Results: The two-item questionnaire, achieved a sensitivity of 90.7% (95% CI 76.9—97.0) but a lower specificity of 67.7% (95% CI 58.7—75.7). The false positive rate was 32.3% (95% CI 24.3—41.3), but the false negative rate was found to be a low 9.3% (95% CI 3.0—23.1). A subgroup analysis of individuals with a past experience of depressive illness, ( n = 95), revealed that a significant number screened positive for depression by the screening test, 55.2% (16/29) compared to those with no background history of depression, 33.3% (22/66) ( P = 0.045). Conclusion: The high sensitivity and low false negative rate of the two-question screening tool will aid health professionals in identifying depression in the in-patient specialist palliative care unit. Individuals, who admit to a previous experience of depressive illness, are more likely to respond positively to the two-item questionnaire than those who report no prior history of depressive illness ( P = 0.045). Palliative Medicine 2007; 21: 193—198