Comparing the accuracy of brief versus long depression screening instruments which have been validated in low and middle income countries: a systematic review

We conducted a search of PUBMED, the COCHRANE library, AIDSLINE, and PSYCH-Info from their inception up to July 2011, for studies that validated depression screening instruments in LMIC. Data were extracted into tables and analyzed using RevMan 5.0 and STATA 11.2 for the presence of heterogeneity.Nineteen studies met our inclusion criteria. The reported prevalence of depression in LMIC ranged from 11.1 to 53%. The area under curve (AUC) scores of the validated instruments ranged from 0.69-0.99. Brief as well as long screening instruments showed acceptable accuracy (AUC≥0.7). Five of the 19 instruments were validated within HIV settings. There was statistically significant heterogeneity between the studies, and hence a meta-analysis could not be conducted to completion. Heterogeneity chi-squared = 189.23 (d.f. = 18) p<.001.Brief depression screening instruments in both general and HIV-PHC are as accurate as the long ones. Brief scales may have an edge over the longer instruments since they can be administered in a much shorter time. However, because the ultra brief scales do not include the whole spectrum of depression symptoms including suicide, their use should be followed by a detailed diagnostic interview.Depression is a prevalent and disabling condition in both high and low income countries [1-3]. According to the World Health Organization, depression is the 4th most disabling medical disorder, and is predicted to be the 2nd most disabling medical condition by 2020 [1,4]. The 12-month prevalence of depression has been reported as 4.1%, with a lifetime prevalence of 6.7% [5].Treatment guidelines developed in high income countries (HIC) recommend routine screening for depression in primary health care (PHC) as an initial step in holistic patient care [6-8]. A number of brief (≤12 items) instruments including the patient health questionnaire (PHQ-9) [9,10] and the Kessler-10 (K-10) [11] have been validated in low and middle income countries (LMIC). Similarly, longe