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INTRODUCTION: Subjects with bipolar disorder suffering of a depressive episode are frequently misdiagnosed as unipolar depression, being important studies assessing the differential diagnosis between bipolar and unipolar depression. OBJECTIVE: To assess the sociodemographic and clinical features of drug-free young adults in a depressive episode of bipolar or unipolar disorder in order to identify factors that may differentiate these psychiatric conditions. METHODS: This is a cross-sectional study with 241 young adults aged between 18 and 29 years who were evaluated using the Structured Clinical Interview for DSM-IV (SCID). The sample comprised patients with BD (n = 89) and major depressive disorder (n = 152), experiencing a depressive episode and not using psychoactive drugs or illicit psychoactive substances. RESULTS: The characteristics associated with bipolar depression were being male (p < 0.001), with a family history of BD (p = 0.013), a higher frequency of childhood traumatic experiences (p = 0.001), younger age of onset of mood disorder (p = 0.004), many previous depressive episodes (p = 0.027), greater severity of depressive symptoms (p < 0.001) and day/night reversal (p = 0.013). Those with unipolar depression showed a higher frequency of biological rhythm disturbances (p < 0.001), and diurnal preference (p = 0.028). LIMITATIONS: The sample has not included subjects with severe suicide risk, a possible important marker in differentiate unipolar from bipolar depression. CONCLUSION: Some clinical aspects may contribute to an early differential diagnosis of both bipolar and unipolar depression even in the initial stages of the disease.

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This population-based study focused on the validity of the Patient Health Questionnaire-9 (PHQ-9) for screening major depressive episodes in the general population in Pelotas, Rio Grande do Sul State, Brazil. Households were selected by multi-stage sampling, and adults (> 20 years) were invited to participate. The gold standard was the structured diagnostic Mini International Neuropsychiatric Interview (MINI), applied by psychiatrists and psychologists. Both the PHQ-9 and the MINI were applied in the subjects' homes. In a total of 447 participants (191 men and 256 women), the continuous analysis identified > 9 as the cutoff point with the highest sensitivity (77.5%; 61.5-89.2) and specificity (86.7%; 83.0- 89.9). Use of the test's algorithm decreased the sensitivity to 42.5% (27.0-59.1), while the specificity increased to 95.3% (92.8-97.2). The PHQ-9 proved appropriate for screening major depressive episodes. For greater sensitivity, the continuously scored PHQ-9 proved more adequate than the algorithm for screening major depressive episodes in the community.

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Com o objetivo de estudar a validade do Patient Health Questionnaire-9 (PHQ-9) no rastreio de episódio depressivo maior na população geral, conduziu-se um estudo de base populacional em Pelotas, Rio Grande do Sul, Brasil. Os domicílios foram sorteados por amostragem em múltiplos estágios, sendo os adultos (> 20 anos) convidados a participar. O padrão ouro foi a entrevista diagnóstica estruturada Mini International Neuropsychiatric Interview (MINI) aplicada por psiquiatras e psicólogos. Tanto o PHQ-9 quanto o MINI foram aplicados no domicílio. Em um total de 447 participantes (191 homens e 256 mulheres) a análise contínua identificou o ponto de corte > 9 como de máxima sensibilidade (77,5%; 61,5-89,2) e especificidade (86,7%; 83,0-89,9). Usando o algoritmo do teste, houve diminuição da sensibilidade para 42,5% (27,0-59,1), enquanto que a especificidade aumentou para 95,3% (92,8-97,2). O PHQ-9 mostrou-se apropriado para rastreamento de episódio depressivo maior. Pela maior sensibilidade, o PHQ-9 pontuado de forma contínua mostrou-se mais adequado do que o algoritmo para rastreamento de episódio depressivo maior na comunidade.

This population-based study focused on the validity of the Patient Health Questionnaire-9 (PHQ-9) for screening major depressive episodes in the general population in Pelotas, Rio Grande do Sul State, Brazil. Households were selected by multi-stage sampling, and adults (> 20 years) were invited to participate. The gold standard was the structured diagnostic Mini International Neuropsychiatric Interview (MINI), applied by psychiatrists and psychologists. Both the PHQ-9 and the MINI were applied in the subjects' homes. In a total of 447 participants (191 men and 256 women), the continuous analysis identified > 9 as the cutoff point with the highest sensitivity (77.5%; 61.5-89.2) and specificity (86.7%; 83.0- 89.9). Use of the test's algorithm decreased the sensitivity to 42.5% (27.0-59.1), while the specificity increased to 95.3% (92.8-97.2). The PHQ-9 proved appropriate for screening major depressive episodes. For greater sensitivity, the continuously scored PHQ-9 proved more adequate than the algorithm for screening major depressive episodes in the community.

Con el objetivo de evaluar la validez del Cuestionario de Salud del Paciente-9 (PHQ-9) en la detección de un episodio depresivo mayor en la población general, se llevó a cabo un estudio de base poblacional en la ciudad de Pelotas, Rio Grande do Sul, Brasil. Los hogares se seleccionaron al azar a través de muestreo multietápico, siendo solo invitados a participar los adultos (> 20 años). El padrón de primer orden fue la Mini Entrevista Neuropsiquiátrica Internacional (MINI), aplicada por psiquiatras y psicólogos. Ambos instrumentos fueron aplicados en la casa del participante. De un total de 447 participantes (191 hombres y 256 mujeres), el análisis continuo mostró un punto de corte > 9 como el de máxima sensibilidad (77,5%; 61,5-89,2) y especificidad (86,7%; 83,0-89,9) para la identificación de un episodio depresivo mayor. Al utilizar el algoritmo del test, la sensibilidad disminuyó a un 42,5% (27,0-59,1), mientras que la especificidad aumento a un 95,3% (92,8-97,2). El PHQ-9 mostró ser adecuado para el cribado de un episodio depresivo mayor. Debido a la sensibilidad más alta, el PHQ-9 marcado como una variable continua fue más adecuado que el algoritmo para la detección de episodio depresivo mayor en la comunidad.

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