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Accuracy of specific symptoms in the diagnosis of major depressive disorder in psychiatric out-patients: data from the MIDAS project

Published online by Cambridge University Press:  12 November 2008

A. J. Mitchell ,
J. B. McGlinchey ,
D. Young ,
I. Chelminski  and
M. Zimmerman
A. J. Mitchell*
Affiliation:
Liaison Psychiatry, Leicester General Hospital and Department of Cancer and Molecular Medicine, Leicester Royal Infirmary, Leicester, UK
J. B. McGlinchey
Affiliation:
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, RI, USA
D. Young
Affiliation:
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, RI, USA
I. Chelminski
Affiliation:
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, RI, USA
M. Zimmerman
Affiliation:
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, RI, USA
*
*Address for correspondence: A. J. Mitchell, MBBS, Consultant in Liaison Psychiatry, Leicester General Hospital, Leicester LE5 4PW, UK. (Email: [email protected])
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Abstract

Background

Background. There is uncertainty about the diagnostic significance of specific symptoms of major depressive disorder (MDD). There is also interest in using one or two specific symptoms in the development of brief scales. Our aim was to elucidate the best possible specific symptoms that would assist in ruling in or ruling out a major depressive episode in a psychiatric out-patient setting.

Method

A total of 1523 psychiatric out-patients were evaluated in the Methods to Improve Diagnostic Assessment and Services (MIDAS) project. The accuracy and added value of specific symptoms from a comprehensive item bank were compared against the Structured Clinical Interview for DSM-IV (SCID).

Results

The prevalence of depression in our sample was 54.4%. In this high prevalence setting the optimum specific symptoms for ruling in MDD were psychomotor retardation, diminished interest/pleasure and indecisiveness. The optimum specific symptoms for ruling out MDD were the absence of depressed mood, the absence of diminished drive and the absence of loss of energy. However, some discriminatory items were relatively uncommon. Correcting for frequency, the most clinically valuable rule-in items were depressed mood, diminished interest/pleasure and diminished drive. The most clinically valuable rule-out items were depressed mood, diminished interest/pleasure and poor concentration.

Conclusions

The study supports the use of the questions endorsed by the two-item Patient Health Questionnaire (PHQ-2) with the additional consideration of the item diminished drive as a rule-in test and poor concentration as a rule-out test. The accuracy of these questions may be different in primary care studies where prevalence differs and when they are combined into multi-question tests or algorithmic models.

Keywords

Clinical utilitydiagnostic accuracymajor depressionsensitivityspecificity
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 7 , July 2009 , pp. 1107 - 1116
Copyright
Copyright © 2008 Cambridge University Press

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