Improving the Detection of Depressive Disorder in Sri Lanka (Pages 25-34)

Yezarni Wynn1, Urvashi Prasad1, Shehan Williams2, Sasmitha Karunarathna3, Supun Withana4, Dinusha Perera5, Kumara Mendis6 and Arun Ravindran7

1Resident Physician, University of Toronto, Department of Psychiatry, Toronto, Canada; 2Professor, Staff Psychiatrist, University of Kelaniya, Department of Psychiatry, Ragama, Sri Lanka; 3Demonstrator, Pre-intern Physician, University of Kelaniya, Department of Psychiatry, Ragama, Sri Lanka; 4Lecturer, Staff Family Physician, University of Kelaniya, Department of Family Medicine, Ragama, Sri Lanka; 5Senior Lecturer, Staff Family Physician, University of Kelaniya, Department of Family Medicine, Ragama, Sri Lanka; 6Professor, Staff Family Physician, University of Kelaniya, Department of Family Medicine, Ragama, Sri Lanka; 7Professor, Department of Psychiatry, University of Toronto, Department of Psychiatry, Toronto, Canada

DOI: https://doi.org/10.12970/2310-8231.2020.08.06

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Abstract: Background: Primary care is often the first point of contact that patients with mental illness have with the healthcare system. Numerous tools have been developed for detecting depression in primary care. However, utilizing these tools within the time-limited primary care setting remains a challenge. Screening questionnaires that are just as effective as more comprehensive diagnostic tools may be beneficial in improving depression detection rates. This study aims to develop a culturally-adapted screening questionnaire and determine its sensitivity and specificity for diagnosing depression in a primary care clinic in Ragama, Sri Lanka.
Methods: This was a cross-sectional study involving three steps; 1) development of the 2-Question Questionnaire (2-QQ), 2) verbal administration of 2-QQ to patients via their primary care physician and 3) completion of the Perideniya Depression Scale (PDS), a validated diagnostic tool for depression, by the patient after their primary care consultation. Correlations between the 2-QQ and PDS were subsequently examined to determine sensitivity and specificity of the 2-QQ.
Results: A score of ≥1 on the 2-QQ was most sensitive but least specific; this threshold level correctly identifies depressed patients, but also inaccurately captures patients who are not depressed. A score of 6 was most specific but least sensitive; this threshold level correctly identifies patients without depression, but is not very effective at capturing patients with depression.
Conclusion: In the context of primary care, it may be worthwhile setting the 2-QQ at a lower threshold for positivity (such as ≥1) to ensure that depressed patients are well-accounted for.

Keywords: Depressive Disorder, Depression, Primary Care, Screening, Clinical Diagnosis.
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