Development of a Brief Screening Instrument: The HANDS

Baer, Lee; Jacobs, Douglas G.; Meszler-Reizes, Joelle; Blais, Mark A.; Fava, Maurizio; Kessler, Ronald C.; Magruder, Kathryn M.; Murphy, Jane M.; Kopans, Barbara; Cukor, Peter; Leahy, Linda; O′Laughlen, John

doi:10.1159/000012364

Cited by 117 publications

(102 citation statements)

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“…[16][17][18] Nevertheless, screening positive for depression is not equivalent to being diagnosed with a major depressive episode. Even screening instruments with laudable test characteristics such as the HANDS, which has a sensitivity of 95% and a specificity of 94% for detecting a DSM-IV-diagnosed major depressive episode, 12 can yield high false positives. 12,19 False positives may particularly occur in settings with higher base rates of depression, like medical settings.…”

Section: Discussionmentioning

confidence: 99%

“…Even screening instruments with laudable test characteristics such as the HANDS, which has a sensitivity of 95% and a specificity of 94% for detecting a DSM-IV-diagnosed major depressive episode, 12 can yield high false positives. 12,19 False positives may particularly occur in settings with higher base rates of depression, like medical settings. Many of the patients in our sample who screened positive for depression may have a subthreshold level of depression, transient depressed mood, or some other psychiatric condition.…”

Section: Discussionmentioning

confidence: 99%

“…To identify cases of depression, we collapsed the "likely" and "highly likely" categories to form 1 group (depression likely), as recommended by Baer and colleagues. 12 Moreover, further evaluation by a physician was recommended for any individual who scored a 1 or higher on the suicide question, regardless of the total score. The HANDS has good internal consistency reliability (α = 0.87) and construct validity as evidenced by high correlations with other validated measures of depression.…”

Section: Methods Of Measurement Data Collection Data Processingmentioning

confidence: 99%

“…The HANDS has good internal consistency reliability (α = 0.87) and construct validity as evidenced by high correlations with other validated measures of depression. 12 The sensitivity and specificity for the 9+ cutoff in a sample of community participants are 95% and 94%, respectively. A score of 17+ improves specificity to 100% but decreases sensitivity to 41%.…”

Section: Methods Of Measurement Data Collection Data Processingmentioning

confidence: 99%

“…10,11 The Harvard Department of Psychiatry's National Depression Screening Day Scale (HANDS) was created specifically to provide a brief, reliable, valid screening measure that maximizes sensitivity and specificity and could be used across a range of settings. 12 We conducted a prospective screening study using the HANDS in a general adult ED population in an effort to provide preliminary data on prevalence and predictors of depression among general ED patients. We hypothesized that depression would be more common in the ED setting than in national community-based estimates and that depression would be more likely among patients with a psychiatric or substance abuse history and those who suffer from a chronic illness.…”

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confidence: 99%

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A Prospective Study of Depression Among Adult Patients in an Urban Emergency Department

Boudreaux¹,

Cagande²,

Kilgannon³

et al. 2006

Prim. Care Companion CNS Disord.

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Objective:To determine prevalence and predictors of depression among emergency department (ED) patients.Method: For 1 week in November 2003, consecutive adult patients presenting to an urban ED from 8:00 a.m. to midnight were screened for a DSM-IV major depressive episode using the Harvard Department of Psychiatry National Depression Screening Day Scale. Patients who were severely ill or who had altered mental status were excluded. Demographic factors, psychiatric history, and brief medical history also were assessed.Results: Of 182 patients enrolled, 57 (32%, 95% CI = 25 to 39) screened positive for depression, which was much greater than general community estimates (6.6%, p < .0001). Depression was more likely (p < .001) in patients with a psychiatric history (61% vs. 22%), substance abuse history (65% vs. 30%), or a suicide attempt (67% vs. 30%). Eleven percent (95% CI = 7 to 17) of subjects endorsed suicidal ideation at least "some of the time."Limitations: This sample underrepresented severely ill, acutely distressed, or cognitively disabled patients. The most likely effect of these exclusion criteria was to yield an underestimate of depression. Also, the ED was located in a northeastern, urban city, which may not represent the rest of the country. Finally, we used a screening instrument without established operating characteristics within the ED setting.Conclusion: Although findings suggest that depression is common, it is often ignored in the ED setting. Recent efforts to increase awareness of depression in outpatient medical settings may be warranted in EDs as well.(Prim Care Companion J Clin Psychiatry 2006;8:66-70)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methods Of Measurement Data Collection Data Processingmentioning

confidence: 99%

Section: Methods Of Measurement Data Collection Data Processingmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

A Prospective Study of Depression Among Adult Patients in an Urban Emergency Department

Boudreaux¹,

Cagande²,

Kilgannon³

et al. 2006

Prim. Care Companion CNS Disord.

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Prevalence of Depression and Depressive Symptoms Among Resident Physicians

Mata

Ramos

Bansal

et al. 2015

JAMA

997

764

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IMPORTANCE Physicians in training are at high risk for depression. However, the estimated prevalence of this disorder varies substantially between studies. OBJECTIVE To provide a summary estimate of depression or depressive symptom prevalence among resident physicians. DATA SOURCES AND STUDY SELECTION Systematic search of EMBASE, ERIC, MEDLINE, and PsycINFO for studies with information on the prevalence of depression or depressive symptoms among resident physicians published between January 1963 and September 2015. Studies were eligible for inclusion if they were published in the peer-reviewed literature and used a validated method to assess for depression or depressive symptoms. DATA EXTRACTION AND SYNTHESIS Information on study characteristics and depression or depressive symptom prevalence was extracted independently by 2 trained investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using meta-regression. MAIN OUTCOMES AND MEASURES Point or period prevalence of depression or depressive symptoms as assessed by structured interview or validated questionnaire. RESULTS Data were extracted from 31 cross-sectional studies (9447 individuals) and 23 longitudinal studies (8113 individuals). Three studies used clinical interviews and 51 used self-report instruments. The overall pooled prevalence of depression or depressive symptoms was 28.8% (4969/17 560 individuals, 95% CI, 25.3%-32.5%), with high between-study heterogeneity (Q = 1247, τ2 = 0.39, I2 = 95.8%, P < .001). Prevalence estimates ranged from 20.9% for the 9-item Patient Health Questionnaire with a cutoff of 10 or more (741/3577 individuals, 95% CI, 17.5%-24.7%, Q = 14.4, τ2 = 0.04, I2 = 79.2%) to 43.2% for the 2-item PRIME-MD (1349/2891 individuals, 95% CI, 37.6%-49.0%, Q = 45.6, τ2 = 0.09, I2 = 84.6%). There was an increased prevalence with increasing calendar year (slope = 0.5% increase per year, adjusted for assessment modality; 95% CI, 0.03%-0.9%, P = .04). In a secondary analysis of 7 longitudinal studies, the median absolute increase in depressive symptoms with the onset of residency training was 15.8% (range, 0.3%-26.3%; relative risk, 4.5). No statistically significant differences were observed between cross-sectional vs longitudinal studies, studies of only interns vs only upper-level residents, or studies of nonsurgical vs both nonsurgical and surgical residents. CONCLUSIONS AND RELEVANCE In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among resident physicians was 28.8%, ranging from 20.9% to 43.2% depending on the instrument used, and increased with calendar year. Further research is needed to identify effective strategies for preventing and treating depression among physicians in training.

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A 52-Year-Old Suicidal Man

Jacobs¹

2000

JAMA

Self Cite

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almost jumped in front of a moving train. He attributes this episode to gambling debts piled up in the prior 6 months and the ensuing conflict with his family. He is a resident of Boston and has health insurance through his blue-collar job.Mr D describes a history of depression dating to his youth. He grew up in a "tough" family, with a father who gambled and drank and brothers who used drugs and alcohol. He has had suicidal thoughts on many occasions but strongly contemplated suicide only once before when he was briefly held in solitary confinement while in jail for a minor crime.Despite attending a gambling addiction program, he relapsed and lost several thousand dollars gambling. His problem was magnified because he lost another individual's money as well. A family member was terminally ill at this time, and Mr D got little food or sleep. He considered staging his own accidental death so his family could collect on his life insurance. He denied any access to firearms. His family encouraged him to voluntarily admit himself to the psychiatric ward.Mr D described his mood as "hopeless," with diminished appetite, poor sleeping, and decreased energy and ability to concentrate. He described feelings of shame and guilt. When asked why he did not jump, he answered that his religious beliefs held him back. In addition, a relative had committed suicide some years ago, and he felt some obligation to "help others prevent that." Mr D has no prior psychiatric hospitalizations. He denied current alcohol use and admitted to past use of marijuana and LSD as a teenager. He quit smoking cigarettes many years ago. Mr D erratically attends a gambling addiction program and is in treatment with a psychiatrist who monitors his medication use. His past medical history is unremarkable.Mr D completed high school and some college, has been married for 3 decades, and has children in their early 20s who are "doing well."He is currently taking fluoxetine hydrochloride, 40 mg daily, and trazodone hydrochloride, 50 mg daily.On examination, Mr D exhibits a depressed affect with slowed speech. He tends to avoid eye contact, although he became more engaged throughout the interview. There was no psychotic content. He did not know when he would be ready to leave the psychiatric ward.

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Development of a Brief Screening Instrument: The HANDS

Cited by 117 publications

References 9 publications

A Prospective Study of Depression Among Adult Patients in an Urban Emergency Department

A Prospective Study of Depression Among Adult Patients in an Urban Emergency Department

Prevalence of Depression and Depressive Symptoms Among Resident Physicians

A 52-Year-Old Suicidal Man

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