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Background: Case finding for low mood is essential in primary care, but it is time-consuming using current depression inventories. The Burns Depression Scale Today (BDST) is a short, simple inventory which assesses mood for today, and we aimed to validate it in this study. Materials and Methods: Consecutive patients with emotional distress seen in a single primary care clinic by one of the authors over 22 months were eligible for this retrospective audit (N = 160). Multiple visits (N = 421) from the same patient were included in the study. The index test was BDST, which assesses the patient's mood for today. The reference standard was the 9-item Patient Health Questionnaire (PHQ-9), which assesses mood over the past 2 weeks. PHQ-9 had a cut-off point of =10 and BDST had a cut-off point of =6 for a significant mood issue. Results: The median age of patients was 35 years, and 63% of the cohort were women. The median BDST score was 8, indicative of moderately low mood, and the median PHQ-9 score was 15, indicative of moderately severe depression. For patients with a BDST score =6, the likelihood ratio of a positive test was 2.67. The sensitivity was 85% (95% confidence interval [CI]: 89%-96%) and the specificity was 68% (95% CI: 60%-76%). The area under the curve was 84% (95% CI: 80%-87%). Conclusion: This audit validates BDST against PHQ-9 and finds it an excellent case-finding tool compared to PHQ-9. This is the first validation study of BDST. [ABSTRACT FROM AUTHOR]

Background: The first consultation with a depressed patient is important because many patients do not return for subsequent visits. Therefore, the first consultation provides a unique opportunity for diagnosis (if required) and treatment, but there are risks of both under and over-diagnosis. Aim: To understand how general practitioners utilize diagnosis when patients present with a new episode of depression. Method: We approached a random selection of twenty-one general practitioners (GPs) in Auckland, New Zealand and asked them to participate in a semi-structured telephone interview. The interviews explored "the first consultation for a depressed/distressed patient" were undertaken to theme saturation. Interviews were hand-written and later transcribed. Results: We identified three major themes in GPs' approach to diagnosis. The issue of diagnosis was underpinned by a complex understanding of depression and the GP role. GPs did not always make a formal diagnosis, but the experience of a patient's distress/depression was understood by drawing on a range of factors and resources. These included time, screening tools, clinician experience, and patient affect. GPs were careful about how they communicated a diagnosis, both in their documentation and in their conversations with patients. Conclusion: At an initial appointment, the distressed/depressed patient can present to their GP with various symptoms and differing degrees of distress. GPs draw upon a variety of skills and resources to negotiate these complexities. The value of a diagnosis was questioned and issues such as impairment may be more useful concepts for GPs. This is the first study to report the findings of the first visit. [ABSTRACT FROM AUTHOR]

Introduction: The first primary care consultation for patients with depression can have long-term consequences for patients, but little is known about treatment decisions at this visit. The aim of this study was to explore the treatment of patients presenting in primary care with a new episode of depression and the drivers behind GPs' treatment decisions at the initial consultation. Materials and Methods: A random sample of GPs in Auckland was invited to participate. A qualitative study was undertaken using semi-structured interviews. Interview transcripts were analyzed using a general inductive approach. Results: Twenty-one GPs were interviewed. We identified three themes as drivers of treatment decisions at the first visit: characteristics of GPs, characteristics of patients, and characteristics of treatment options. Drivers for prescribing were severe depression and time constraints. A driver for non-pharmacological treatment was a strong doctor–patient relationship. Limited time, skill, and training were associated with low confidence using talking therapies. Access to counseling was reported as poor. There was a very wide range of approaches taken. GPs described preferring antidepressants less and talking therapies more with Mčori patients. Behavioral activation was used least despite its ease of use and it being one of the most effective treatments for depression. Conclusion: Treatment of depression at the first visit varies widely between practitioners. GPs report multiple barriers to the provision of talking therapies. A move to a more standardized approach may lead to more equitable care. This is the first study to report findings about the initial primary care consultation for depression. [ABSTRACT FROM AUTHOR]

Background: Case-finding for low mood in primary care can be time-consuming using current depression inventories. Aim: To assess the diagnostic accuracy, of a single verbally administered question on the emotional quality of life (Emoqol 100), for low mood in patients with symptoms of distress in an ambulatory care setting. Design and setting: Eligible patients were consecutive patients seen by one of the authors over 13 months with possible distress/low mood. The index test was the verbally asked Emoqol 100, which is the patient's emotional quality of life now, with 100 being perfect emotional health and 0 being the worst imaginable. The reference standard is the written version of the PHQ-9 with a cut point of ≥10. Methods: A retrospective audit of consecutive consultations in a single primary care clinic. Results: One hundred two patients were seen during the study period, of which 76 met the eligibility criteria for this audit, and there were 215 test results. For a cut point of <50 on the Emoqol 100 and the PHQ-9 ≥10 the sensitivity was 47% (95% CI 39-54), and the specificity was 93% (95% CI 86-100). The positive predictive value was 95%, and the negative predictive value was 37%. Conclusion: This is the first accuracy estimation of the Emoqol 100. It appears to have a high specificity which means when it is positive (<50) it is a good estimate of a high PHQ-9, i.e. a mood issue probably exists. The test will be helpful for busy primary care clinicians as it takes less than 15 seconds to verbally administer. [ABSTRACT FROM AUTHOR]