The Accuracy, Efficiency, and Appropriateness of Two Self-Administrative Scales to Screen for Major Depressive Disorder

Identifying patients with major depressive disorder (MDD) in communities and providing appropriate treatment are important means to prevent suicide. The aim of this study was to find a highly capable scale to identify MDD patients and to clarify the appropriateness of administering screening for MDD after informed consent is given. A mental health questionnaire survey was conducted in Niigata City and was answered by 1,001 persons. After being informed that the survey was to screen for MDD, 153 persons accepted (screening survey). Two self-administrative scales were administered: the Center for Epidemiologic Studies Depression Scale (CES-D) and the K6 scale. The Structured Clinical Interview for DSM-IV Axis-I Disorders (SCID) was also applied, and seven individuals were judged as positive for MDD. Receiver Operating Characteristic (ROC) curves for MDD, indicated that CES-D (0.932) had a wider area under the curve than K6(0.874). The optimum screening criterion of CES-D was "≥14 points" based on the Youden index and the ROC curve. By using this criterion, the sensitivity for MDD was 1.00, and its positive predictive value was greater than K6 under any conditions examined. According to the mental health questionnaire survey, the prevalence of depressive symptoms in 848 non-participants of the screening survey was clearly lower than in the 146 SCID-negative participants for MDD. In conclusion, CES-D is a capable scale to identify patients with MDD. The administration of CES-D to participants of a screening survey can be a practical way to effectively and efficiently find patients with MDD within a community