Evaluating gender differences in depression screening: diagnostic accuracy and measurement invariance of the DESY-PC questionnaire in primary care.

Background

Recent advances in depression diagnostics emphasize gender-specific evaluations to avoid measurement bias, given gender disparities in prevalence and symptom presentation. This study evaluated the psychometric performance of the newly developed "Questionnaire for the assessment of DEpression SYmptoms in Primary Care" (DESY-PC) in women and men.

Methods

We conducted a secondary data analysis of a diagnostic cross-sectional study involving 431 primary care patients. Current depression diagnosis was assessed using the Structured Clinical Interview for DSM-V disorders (SCID-V-CV) as the reference standard. Gender-specific diagnostic accuracy was evaluated using Receiver Operating Characteristic (ROC) analyses, including Area Under the Curve (AUC), sensitivity, and specificity. AUC values were compared to those of the commonly used PHQ-9 (Patient Health Questionnaire-9). Measurement invariance across genders was assessed by Multigroup Confirmatory Factor Analysis (Multigroup-CFA).

Results

Among 431 participants (61% women, mean age 47.6 years), the DESY-PC demonstrated comparable diagnostic accuracy, with an AUC of 0.85 (95%CI: 0.80-0.91) for women and 0.90 (95%CI: 0.83-0.97) for men (p = 0.340). At the cut-off score of 16, sensitivity (women: 74%, men: 83%; p = 0.422) and specificity (women: 82%, men: 87%; p = 0.220) were comparable across genders. The PHQ-9 showed a significantly higher AUC for men (0.90) than for women (0.78; p = 0.048). Multigroup-CFA confirmed measurement invariance of the DESY-PC across genders.

Conclusion

The DESY-PC demonstrated high and comparable diagnostic accuracy across genders and assessed the same constructs in women and men. These findings support its suitability as a gender-sensitive tool for depression screening in primary care.