Diagnostic accuracy of the Whooley depression tool in older adults in UK primary care

- Index test performance against reference standard to identify depression.
- High sensitivity, moderate specificity: good at ruling out depression.
- Potential value in primary care where depression typically under-recognized.
- High false positive rate: extra burden on GPs to perform more detailed assessments.
- If subthreshold depression identified, it could trigger activity and surveillance.

Purpose of researchTo validate the Whooley questions as a screening tool for depression amongst a population of older adults in UK primary care.ObjectiveTo assess the diagnostic performance of the Whooley questions as a screening tool for depression amongst older adults in UK primary care.ParticipantsA cross-sectional validation study was conducted with 766 patients aged ≥75 from UK primary care, recruited via 17 general practices based in the North of England during the pilot phase of a randomized controlled trial.Main outcome measuresSensitivity, specificity and likelihood ratios comparing the index test (two Whooley questions) with a diagnosis of major depressive disorder (MDD) ascertained by the reference standard Mini International Neuropsychiatric Interview (MINI).ResultsThe two screening questions had a sensitivity of 94.3% (95% confidence interval, 80.8-99.3%) and specificity of 62.7% (95% confidence interval, 59.0-66.2%). The likelihood ratio for a positive test was 2.5 (95% confidence interval, 2.2-2.9) and the likelihood ratio for a negative test was 0.09 (95% confidence interval, 0.02-0.35).ConclusionThe two Whooley questions missed few cases of depression. However, they were responsible for a high rate of false positives. This creates additional burden on general practitioners, to conduct more detailed investigation on patients who screen positive, but many of whom turn out not to have MDD.