An Assessment of the Screening Performance of a Single-Item Measure of Depression From the Edmonton Symptom Assessment Scale Among Chronically Ill Hospitalized Patients

ContextFew studies have examined the validity of using a single item from the Edmonton Symptom Assessment Scale (ESAS) for screening for depression.ObjectivesTo examine the screening performance of the single-item depression question from the ESAS in chronically ill hospitalized patients.MethodsA total of 162 chronically ill inpatients aged 65 and older completed a survey after admission that included the well-validated, 15-item Geriatric Depression Scale (GDS-15) and four single-item screening questions for depression based on the ESAS question, using two different time frames (“now” and “in the past 24 hours”) and two response categories (a 0–10 numeric rating scale [NRS] and a categorical scale: none, mild, moderate, and severe).ResultsThe GDS-15 categorized 20% (n = 33) of participants as possibly being depressed with a score ≥6. The NRS for depression “now” achieved the highest level of sensitivity at a cutoff ≥ 1 (68.8%), and an acceptable level of specificity was obtained at a cutoff of ≥5 (82.2%). For depression “in the past 24 hours,” a cutoff of ≥1 achieved a sensitivity of 68.8% and a cutoff of ≥7 a specificity of 80.3%. For the categorical scale, a cutoff of “none” provided the best level of sensitivity for depression “now” (65.6%) and “in the past 24 hours” (81.3%), with an acceptable level of specificity being obtained at ≥“mild” (68.8%) and ≥“moderate” (68.8%), respectively.ConclusionThese single-item measures were not effective in screening for probable depression in chronically ill patients regardless of the time frame or the response format used, but a cutoff of ≥5 or “mild” or greater did achieve sufficient specificity to raise clinical suspicion.