Improving the Efficiency of Screening for Major Depression in People With Spinal Cord Injury

J Spinal Cord Med, 2008 · DOI: · Published: January 1, 2008

Simple Explanation

Major depression is a common and serious condition for people with spinal cord injury (SCI). This study aimed to find a quick way to screen for depression in this group. Researchers looked at a shorter version of a depression questionnaire (PHQ-9) to see if it could effectively identify people with probable major depression. The study found that a 3-item version of the PHQ-9 worked well for screening purposes and could help clinicians identify those who need further evaluation.

Study Duration

October 2000 through April 2003

Participants

3,652 persons with traumatic SCI

Evidence Level

Not specified

Key Findings

1
A 3-item scale (items 1, 2, and 6 from the PHQ-9) has a relative efficiency of 0.66 compared to the full 9-item scale, meaning it captures two-thirds of the information with one-third of the items.
2
Using a cutoff score of 3 or more on the 3-item scale provides a specificity of 0.93 and sensitivity of 0.87 for detecting probable major depression.
3
The 3-item scale reduces the impact of gender on the score obtained, making it a more equitable screening tool.

Research Summary

This study investigated the effectiveness of a shortened version of the PHQ-9 for screening major depression in individuals with SCI. The results suggest that a 3-item scale comprised of items 1, 2, and 6 of the PHQ-9 provides adequate information for clinical screening purposes and minimizes gender-related response bias. The authors conclude that the 3-item scale can be a valuable tool for identifying individuals with SCI who may benefit from further evaluation and treatment for depression.

Practical Implications

Efficient Screening

The 3-item scale offers a quick and efficient way to screen for depression in busy clinical settings.

Reduced Gender Bias

The 3-item scale minimizes the impact of gender on screening results, promoting fairness.

Targeted Assessment

Clinicians can use the 3-item scale as a first step, followed by the full PHQ-9 for those who screen positive, improving diagnostic specificity.

Study Limitations

1
The criterion for probable major depression was the longer version of the same scale (PHQ-9).
2
Further study is required to determine if the use of the 3-item scale functions as well in an inpatient setting as it does in the outpatients participating in this study.
3
Further studies are required to determine whether the 3-item scale operates as effectively when other measures or clinical interviews are utilized as a criterion.

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