Screening of Depression in Primary Care

1. Screening of Depression in Primary Care 鄭志文醫生 香港大學內外全科醫學士 香港中文大學家庭醫學碩士 英國皇家全科醫學院院士 香港大學社區精神醫學深造文憑

2. Depression is Common The WHO identified depression as the fourth leading cause of worldwide disease in 1990, and depressive illness is projected to be the second leading cause of disability worldwide in 2020. • Murray CJ, Lopez AD. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, Mass.: Harvard University Press, 1996.

3. 根據世界衛生組織研究，抑鬱症將會於2020年成為世界第二位慢性疾病根據世界衛生組織研究，抑鬱症將會於2020年成為世界第二位慢性疾病

4. A recent study by the Mood Disorder Centre of the Chinese University of Hong Kong found that about 8.3 per cent of people had symptoms of depression in the previous 12 months. • SCMP, April 25, 2005

5. Screening for Depression is Useful • In 2002, after a large systematic review, the USPSTF (United States Preventive Service Task Force) recommended screening adults for depression • in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and follow-up.

6. It found good evidence that screening improved the accurate identification of depressed patients in primary care settings • and that treatment of depressed adults identified in primary care settings decreases clinical morbidity. • It concluded that the benefits of screening were likely to out-weight any potential harms

7. Screening Instruments • the Two-question Test (2Q) • the Patient Health Questionnaire (PHQ-9)

8. The 2 Q • During the past month, have you often been bothered by feeling down, depressed, or hopeless? • During the past month, have you often been bothered by little interest or pleasure in doing things?

9. The original PRIME-MD study reported that a "yes" answer to one of these two questions was: • 86% sensitive, and • 75% specific • compared with a subsequent telephone interview diagnosis of major depressive disorder.

10. The PHQ 9

12. The PHQ-9 had been validated in a study involving 3000 primary care patients. • A PHQ-9 score >9 had • a sensitivity of 88% and • a specificity of 88% for major depression

13. Validation is needed • Translation and back-translation • Applied against adult patients of 14 HK family doctors • 357 patients took part • Using the Hamilton Depression Scale as gold standard

14. The 2 Q • 在過去的一個月，您曾否經常被以下事情煩擾： • 幾乎沒有興趣或樂趣去做事 • 感覺情緒低落、抑鬱或絕望

15. The PHQ 9 在過去的兩個星期，您曾否經常被以下問題煩擾着 ? 1.幾乎沒有興趣或樂趣去做事 2.感覺情緒低落，抑鬱或絕望 3.入睡或保持睡眠有困難。或者睡得太多 4.感到疲倦或缺乏體力 5.胃口不好或吃得過量

16. 6.您覺得自卑或自責，或者覺得自己或家人對自己感到失望6.您覺得自卑或自責，或者覺得自己或家人對自己感到失望 7.對事情的集中力有困難，例如閱報或看電視 8.您的活動或說話速度很慢以致別人也留意到。或者情況相反：您感到心煩意亂或坐立不安以致四處走動的情況多於平時 9.有否想到傷害自己，自殺傾向或行為

17. 到目前為止，假如您在這份問卷中檢查出任何問題，您覺得這些問題對您的工作、料理家中的事務或與其他人相處的事情上遇到多少困難？到目前為止，假如您在這份問卷中檢查出任何問題，您覺得這些問題對您的工作、料理家中的事務或與其他人相處的事情上遇到多少困難？

19. Correlation between CHDS and PHQ-9 • The results of the PHQ-9 showed a good correlation with that from the CHDS. • The Pearson Correlation is 0.793. This is statistically significant to the 0.01 level (2-tailed).

20. Sensitivity and specificity of 2Q CHDS <= 16 CHDS > 16 Total 2Q = 0 240 1 241 2Q > 0 87 29 116 Total 327 30 357 • Sensitivity = 96.7% • Specificity = 73.4%

21. Sensitivity and specificity of PHQ-9 CHDS <= 16 CHDS > 16 Total PHQ-9 <= 9 301 6 307 PHQ-9 > 9 26 24 50 Total 327 30 357 • Sensitivity = 80% • Specificity = 92%

24. The EndThank You