Screening for anxiety and depression in primary care with the Duke Anxiety-Depression Scale

Abstract

Background and objectives: Anxiety and depression are highly prevalent and underdiagnosed in primary care. This study tested the seven-item Duke Anxiety-Depression Scale (DUKE-AD) in primary care adult patients as a screener for anxiety and depression as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R).

Methods: Receiver operating characteristic curves (ROC) and odds ratios were used to test screener accuracy, and sensitivities and specificities were used to test screener efficiency in patients with anxiety and/ or depression.

Results: In 481 patients, the ROC area for patients with major anxiety disorders (panic disorder, agoraphobia, or generalized anxiety) was 72.3%. The ROC area for major depressive disorders (major depressive disorder and/or dysthymia) was 78.3%, and the ROC area for both major anxiety and/or depressive disorders was 76.2%. Odds ratios for these same groups after controlling for sociodemographic factors were 1.043, 1.057, and 1.053, respectively. Sensitivities and specificities for these groups at the DUKE-AD score cutoff point of > 30 on a 0-100 scale were 71.4% and 59.2%, 81.8% and 63.6%, and 73.9% and 66.1%, respectively.

Conclusions: The DUKE-AD is a brief, easily scored questionnaire that serves as a valid screener for DSM-III-R anxiety and depression in the primary care setting.