Utility, validity, feasibility and acceptability of a clinician-administered depression, two-question screening tool for routine multiple sclerosis clinic administration

Background: Depression is prevalent among individuals with multiple sclerosis (MS) yet frequently goes undetected and untreated. Time constraints are a barrier to depression screening in MS clinics. We evaluated the clinical utility, diagnostic accuracy and feasibility of the Two-Question Screening tool (2QS) for routine, in-clinic depression screening. Objectives: A prospective cross-sectional study of 207 consecutively recruited adults with MS (M age = 47.3 ± 12.7, 77.3% female) was conducted at a metropolitan MS Clinic. Clinicians administered the 2QS during in-clinic or telehealth consultations. To assess the sensitivity and specificity of the 2QS in identifying depression, participants underwent a Structured Clinical Interview for Diagnostic and Statistical Manual for Mental Disorders – Fifth Edition (SCID-5) for major depressive disorder (MDD), Patient Health Questionnaire-9 (PHQ-9), and the Depression, Anxiety and Stress Scale-21 (DASS-21). Internal consistency, convergent validity and clinician feasibility were assessed. Results: The 2QS had 100% (95% CI: 71%–100%) sensitivity and 68% (95% CI: 60%–76%) specificity for detecting MDD. Clinician screening adherence was 76%. For the in-clinic subsample, clinician-administered 2QS correlations were SCID-5 MDD, r = 0.39 ( r = 0.60 with subthreshold depression symptoms added); PHQ-9, r = 0.73; and DASS-D, r = 0.74. Conclusions: Clinician-administered 2QS is valid and feasible for routine depression screening at MS clinic appointments. With high sensitivity and acceptable specificity, the clinician-administered 2QS is suitable to improve depression detection in people with MS.