Waarde van de Vierdimensionale Klachtenlijst (4DKL) voor het detecteren van depressieve stoornissen

Background: Depressive disorders often go unrecognised in patients consulting for psychological reasons in general practice. A simple questionnaire that the patient can fill in away from the consultation could be helpful in signalling patients with a high probability of having a depressive disorder. Aim: To assess the discriminative power of the depression scale of the 4DSQ with respect to depressive disorders in general practice patients. Method: Fourteen GPs assessed 55 patients with psychological symptoms using the Short Depression Interview to diagnose depressive disorder according to the guidelines of the Dutch College of General Practitioners. Subsequently, the patients filled in a 4DSQ. We used receiver operating characteristic (ROC) analysis to establish the ability of the depression score to discriminate between patients with and without depressive disorder. Logistic regression analysis was used to estimate likelihood ratios for the range of depression scores (0-12). Results: The area under the ROC curve was 0.88 (95% CI 0.79-0.97). The likelihood ratios varied between 0.14 (0.05-0.34) for a depression score of 0 and 18.12 (4.55-72.1) for a depression score of 12. Posterior probabilities for depressive disorder can be calculated using the likelihood ratios, given the prior probability. In patients with conspicuous psychological problems, who have a prior probability of depressive disorder of 25%, depression scores ≥ 7 indicate a relatively high probability of depressive disorders (44-86%), whereas depression scores < 4 make depressive disorder less likely (probability of 4-13%). Conclusions: The 4DSQ depression scale is a useful tool to help the GP detect depressive disorders in patients with psychological problems.