Primary care Screening Questionnaire for Depression: Reliability and validity of a new four-item tool

Abstract

BackgroundUnidentified depression in primary care is a public health concern, globally. There is a need for brief, valid and easily administered tools in primary care.AimsTo estimate reliability and validity of the newly developed Primary care Screening Questionnaire for Depression (PSQ4D), a four-item tool, with ‘yes’ or ‘no’ options.MethodPSQ4D was administered verbally (time required, <1 min) by primary care physicians to adult outpatients (n=827) in six primary care settings in Kerala, India. A psychiatrist evaluated each patient on the same day, using ICD-10 Diagnostic Criteria for Research, based on unstructured clinical interview.ResultsThe Cronbach’s alpha for internal consistency reliability was 0.80; kappa coefficient for test–retest reliability was 0.9 and that for interrater reliability was 0.72. At a score ≥2, sensitivity was 0.96, specificity was 0.87, positive predictive value was 0.74, negative predictive value was 0.98, positive likelihood ratio was 7.4 and negative likelihood ratio was 0.05.ConclusionsWhen physician administered, PSQ4D has good reliability. At a cut-off score of ≥2, it has high sensitivity and specificity to identify depressive disorder in primary care.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Concurrent Validity and Interrater Reliability of the “Clinical Schedules for Primary Care Psychiatry”

“…Changing this threshold to a higher number would lower sensitivity and lowering it would bring down the specificity. 16…”

“…It also grossly lacks integrated, yet comprehensive screener (WHO, 2016). There are many disease-specific screening tools, such as Patient Health Questionnaire- 9 (PHQ-9), 15 Primary Care Screening Questionnaire for Depression (PSD), 16 and Global Mental Health Assessment Tool for Primary Care. 17 However, there are limitations, such as the absence of a single screening tool for most commonlyencountered conditions in primary care, lack of cultural adaptation for Indian settings, and considerations for use in primary care settings.…”

“…17 However, there are limitations, such as the absence of a single screening tool for most commonlyencountered conditions in primary care, lack of cultural adaptation for Indian settings, and considerations for use in primary care settings. 15 16 17 Hence, there is a need of integratedall-in-one tool for PCDs with incorporation of principle of general clinical practice.…”

Health and well-being in small island communities: a cross-sectional study in the Solomon Islands

“…The Primary Care Screening Questionnaire for Depression (PSQ4D) was used to measure depressive mental states. 18 This questionnaire consists of the following four questions, and answering ‘yes’ to three or more questions is recognised as depression: (1) ‘Have you been experiencing sadness or depressed mood during the last 2 weeks or longer?’, (2) ‘Have you been experiencing loss of interest or loss of pleasure in doing things during the last 2 weeks or longer?’, (3) ‘Have you been feeling excessively tired or without energy during the last 2 weeks or longer?’ and (4) ‘Have you been suffering from sleeplessness during the last 2 weeks or longer?’. All four questions are related to four symptoms of depression described in The International Classification of Diseases (ICD)-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research, and none of the questions is culture-specific.…”

“…The Primary Care Screening Questionnaire for Depression (PSQ4D) was used to measure depressive mental states. 18 This questionnaire consists of the following four questions, and answering 'yes' to three or more questions is recognised as depression: (1) 'Have you been experiencing sadness or depressed mood during the last 2 weeks or longer? ', (2) 'Have you been experiencing loss of interest or loss of pleasure in doing things during the last 2 weeks or longer?…”