older psychiatrySigns of depression can be detected in older adults in just 1-2 minutes by using two simple questions, according to a study.

The study, published in the British Journal of Psychiatry and led by Samuel Wong from The Chinese University of Hong Kong, reviewed 113 papers involving 46,651 patients, comparing the screening instrument used against actual diagnoses of adults whose mean age was 60-87 years. 

The Two-Question Screen determines risk of depression by asking older adults 2 questions: ‘Have you been troubled by feeling down, depressed or hopeless?’ and ‘Have you experienced little interest or pleasure in doing things?’ in the past month. Only ‘Yes’ or ‘No’ responses are allowed. Those who seem at risk or show early signs of depression can be referred for further tests. 

The study found that the Geriatric Depression Scale was the most commonly used screening tool, but that the Two-Question Screen was just as accurate compared other longer and more complex processes. 

One in 5 older people have depression and the condition affects 40% of those in care homes. It is under-diagnosed because older people often report depressive symptoms through complaints about physical health.

The authors believe using these two questions could greatly improve detection of depression in this population. As it does not require input from clinicians or specialists, the study shows that the Two-Question Screen is an effective use of resources to accurately, quickly and cheaply identify risk of depression in older people. 

“This meta-analysis shows that self-rating scales have comparable diagnostic performance with clinician-rated scales,” Wong said. “When considering diagnostic performance and administrative convenience, the Two-Question Screen is simple and reliable when screening for depression in older adults. Therefore, it is favourable to use the Two-Question Screen in older adult screening programmes.”

Old age psychiatrist and chair of Royal College of Psychiatrist Old Age Faculty, Dr Amanda Thompsell, said: “I absolutely support the Two-Question Screen. Depression in older people is common but under-recognised. We know that people with two or more chronic physical conditions are seven times more likely to suffer from depression, but mental health needs can be missed amid the overwhelming presence of physical problems. This study shows us a reliable way to detect depression in older people in a wide range of settings. These two questions are so simple that there is no excuse not to use them.”