Medline ® Abstracts for References 2-5
of 'Screening for depression in adults'
Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire.
Spitzer RL, Kroenke K, Williams JB
CONTEXT: The Primary Care Evaluation of Mental Disorders (PRIME-MD) was developed as a screening instrument but its administration time has limited its clinical usefulness.
OBJECTIVE: To determine if the self-administered PRIME-MD Patient Health Questionnaire (PHQ) has validity and utility for diagnosing mental disorders in primary care comparable to the original clinician-administered PRIME-MD.
DESIGN: Criterion standard study undertaken between May 1997 and November 1998.
SETTING: Eight primary care clinics in the United States.
PARTICIPANTS: Of a total of 3000 adult patients (selected by site-specific methods to avoid sampling bias) assessed by 62 primary care physicians (21 general internal medicine, 41 family practice), 585 patients had an interview with a mental health professional within 48 hours of completing the PHQ.
MAIN OUTCOME MEASURES: Patient Health Questionnaire diagnoses compared with independent diagnoses made by mental health professionals; functional status measures; disability days; health care use; and treatment/referral decisions.
RESULTS: A total of 825 (28%) of the 3000 individuals and 170 (29%) of the 585 had a PHQ diagnosis. There was good agreement between PHQ diagnoses and those of independent mental health professionals (for the diagnosis of any 1 or more PHQ disorder, kappa = 0.65; overall accuracy, 85%; sensitivity, 75%; specificity, 90%), similar to the original PRIME-MD. Patients with PHQ diagnoses had more functional impairment, disability days, and health care use than did patients without PHQ diagnoses (for all group main effects, P<.001). The average time required of the physician to review the PHQ was far less than to administer the original PRIME-MD (<3 minutes for 85% vs 16% of the cases). Although 80% of the physicians reported that routine use of the PHQ would be useful, new management actions were initiated or planned for only 117 (32%) of the 363 patients with 1 or more PHQ diagnoses not previously recognized.
CONCLUSION: Our study suggests that the PHQ has diagnostic validity comparable to the original clinician-administered PRIME-MD, and is more efficient to use.
Biometrics Research Department, New York State Psychiatric Institute, and Columbia University, New York 10032, USA. firstname.lastname@example.org
High prevalence of mental disorders in primary care.
Ansseau M, Dierick M, Buntinkx F, Cnockaert P, De Smedt J, Van Den Haute M, Vander Mijnsbrugge D
J Affect Disord. 2004;78(1):49.
OBJECTIVE: To determine the prevalence of common mental disorders in an adult primary care population.
DESIGN: Cross-sectional survey in randomly selected subjects, using the PRIME-MD questionnaire.
SETTING: Eighty-six general practices in Belgium.
SUBJECTS: A total of 2316 randomly selected patients, aged 18 years or older and consulting their general practitioner for other than administrative reasons alone, with slightly more women (58.1%) than men (41.3%). MAIN OUTCOME RESULT: Prevalence rates of mental disorders most commonly seen in primary care practice (mood, anxiety, somatoform, eating and alcohol disorders).
METHODS: To facilitate data collection and processing, the entire PRIME-MD questionnaire was programmed on a handheld computer. Patient answers and physician assessments were immediately electronically recorded during the interview. All investigators were trained on the use of the PRIME-MD. The recruitment period lasted 6 weeks: from 15 February to 25 March 1999, and patients were randomly selected for the interview based on a computerized procedure.
RESULTS: Although only 5.4% of all patients consulted for a psychiatric reason, a threshold/subthreshold psychiatric disorder was detected in 42.5% of all patients. Most commonly detected disorders were mood disorders in 31.0% (major depressive disorder, 13.9% and dysthymia, 12.6%), anxiety disorders in 19.0% (generalized anxiety disorder, 10.3%), somatoform disorders in 18.0% and probable alcohol abuse/dependence in 10.1%. The results also showed the important rate of comorbidity between these disorders.
CONCLUSION: The present study confirms the high prevalence of mental disorders in a general practice setting, and their frequent association. Prevalence rates of our study are even higher than those obtained in previously conducted trials. Our study also demonstrates the utility of the PRIME-MD as a screening tool for mental disorders in primary care. In addition the use of the handheld computer software version of the PRIME-MD allowed us to screen for mental disorders in patients who are unable to attend the GP office and are seen during 'home' visits.
Department of Psychiatry, University of Liège, CHU du Sart Tilman (B35), B-4000 Liège, Belgium. email@example.com
Gender, quality of life, and mental disorders in primary care: results from the PRIME-MD 1000 study.
Linzer M, Spitzer R, Kroenke K, Williams JB, Hahn S, Brody D, deGruy F
Am J Med. 1996 Nov;101(5):526-33.
BACKGROUND: Recently there has been increased interest in the special mental health needs of women. We used data from the PRIME-MD 1000 study to assess gender differences in the frequency of mental disorders in primary care settings, and to explore the potential impact of these differences on health-related quality of life (HRQL).
SUBJECTS AND METHODS: One thousand primary care patients (559 women) were interviewed during the PRIME-MD study, which was conducted at four primary care clinics affiliated with university hospitals throughout the eastern United States. Patients completed a one-page questionnaire in the waiting room prior to being seen by the physician; patients and physicians then completed together a clinician evaluation guide that used DSM-III-R algorithms to diagnose mood, anxiety, somatoform, eating, and alcohol related disorders. Health-related quality of life was assessed with the Medical Outcomes Study SF-20 General Health Survey.
RESULTS: Women were more likely than men to have at least one mental disorder (43% versus 33%, P<0.05). Higher rates were particularly prominent for mood disorders (31% of women versus 19% of men, odds ratio [OR]= 1.9, 95% confidence interval [CI]1.4 to 2.6), anxiety disorders (22% versus 13%, OR = 1.9, CI = 1.3 to 2.8), and somatoform disorders (18% versus 9%, OR = 2.2, CI = 1.5 to 3.4). Psychiatric comorbidity was also more common in women (26% of women had two or more mental disorders versus 15% of men, P<0.05). Unadjusted HRQL scores, ranging from 0 to 100, with 100 = best health, were all significantly lower in women than in men (eg, physical function = 67 in women versus 76 in men, P<0.0001; mental health = 69 in women versus 76 in men, P<0.0001). Many HRQL differences persisted after controlling for age, education, ethnicity, marital status, and number of physical disorders; however, differences in HRQL were eliminated in 5 of 6 domains after controlling for number of mental disorders. When compared with female patients of male physicians, female patients of female physicians demonstrated similar satisfaction with care, health care utilization, HRQL, and recognition rate of mental disorders.
CONCLUSIONS: In the 1,000 patients of the PRIME-MD study, mood, anxiety, and somatoform disorders and psychiatric comorbidity were all significantly more common in women than men. The HRQL scores were poorer in women than men, although most of this difference was accounted for by the difference in prevalence of mental disorders. These data suggest that one of the most important aspects of a primary care physician's care of female patients is to screen for and treat common mental disorders.
Department of Psychiatry, Columbia University, New York, New York, USA.
Prevalence and comorbidity of common mental disorders in primary care.
Roca M, Gili M, Garcia-Garcia M, Salva J, Vives M, Garcia Campayo J, Comas A
J Affect Disord. 2009 Dec;119(1-3):52-8. Epub 2009 Apr 10.
OBJECTIVE: To estimate the prevalence and comorbidity of the most common mental disorders in primary care practice in Spain, using the Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire.
DESIGN: A systematic sample of 7936 adult primary care patients was recruited by 1925 general practitioners in a large cross-sectional national epidemiological study. The PRIME-MD was used to diagnose psychiatric disorders.
SETTING: 1356 primary care units proportionally distributed throughout the country.
RESULTS: 53.6% of the sample presented one or more psychiatric disorder. The most prevalent were affective (35.8%), anxiety (25.6%), and somatoform (28.8%) disorders. 30.3% of the patients had more than one current mental disorder. 11.5% presented comorbidity between affective, anxiety, and somatoform disorders.
CONCLUSIONS: The study provides further evidence of the high prevalence and high comorbidity of mental disorders in primary care. Given the large overlap between affective, anxiety and somatoform disorders, future diagnostic classifications should reconsider the current separation between these entities.
Institut Universitari d'Investigacióen Ciències de la Salut (IUNICS), Juan March Hospital, University of Balearic Islands, Red de Investigación de Actividades Preventivas y Promoción de la Salud (RedIAPP), Palma de Mallorca, Spain. firstname.lastname@example.org