Abstract
We evaluated a set of diagnostic screens for mental disorders in primary care. A self-administered screening questionnaire containing 26 items testing for multiple mental disorders was completed by 1,001 patients. Brief diagnostic modules, structured for psychiatric diagnoses, were subsequently administered to each patient by a research nurse. Operating characteristics of the screens were as follows: alcohol dependence (sensitivity [SE] 0.75; positive predictive value [PPV] 0.58; [κ] 0.63), drug dependence (SE 0.50; PPV 0.50; κ 0.50), generalized anxiety disorder (SE 0.74; PPV 0.44; κ 0.44), major depressive disorder (SE 0.71; PPV 0.52; κ 0.50), obsessive compulsive disorder (SE 0.71; PPV 0.15; κ 0.21), and panic disorder (SE 0.71; PPV 0.43; κ 0.48). Other chance-corrected measures of agreement are also reported, and criterion validity of the screens is examined. The results provide evidence that the screens discriminate between patients with symptomatology meeting established diagnostic criteria and those without. They detected previously unrecognized cases in this study and may prove to be valuable tools for psychiatric diagnosis in primary care.
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References
Burnam MA, Wells KB, Leake B, Landsverk J. Development of a brief screening instrument for detecting depressive disorders. Med Care. 1988;26:775–89.
Apfeldorf WA, Shear MK, Leon AC, Portera L. A brief screen for panic disorder. J Anxiety Disorders. 1994;8:71–8.
Spitzer RL, Williams JBW, Kroenke K, et al. Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study. JAMA. 1994;272:1749–56.
Broadhead WE, Leon AC, Weissman MM, et al. Development and validation of the SDDS-PC screen for multiple mental disorders in primary care. Arch Family Med. 1995;4:211–9.
Roback G, Randolph L, Seidman B, Pasko T. Physician Characteristics and Distribution in the United States. Chicago, Ill: American Medical Association; 1994.
Wachter RM. Rationing health care: preparing for a new era. South Med J. 1995;88:25–32.
Weissman MM, Olfson M, Leon AC, et al. Brief diagnostic interviews (SDDS-PC) for multiple mental disorders in primary care: a pilot study. Arch Family Med. 1995;4:220–7.
American Psychiatric Association. Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
Sheehan DV. The Anxiety Disease. New York, NY: Charles Scribner and Sons; 1983.
Leon AC, Shear MK, Portera L, Klerman GL. Assessing impairment in patients with panic disorder: the Sheehan Disability Scale. Soc Psychiatry Psychiatr Epidemiol. 1992;27:78–82.
Kraemer HC. Evaluating Medical Tests: Objective and Quantitative Guidelines. Newbury Park, Calif: Sage Publication; 1992.
Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Measurement. 1960;20:37–46.
Soost HJ, Lange HJ, Lehmacher W, Ruffing-Kullman B. The validation of cervical cytology: sensitivity, specificity, and predictive values. Acta Cytol. 1991;35:8–14.
Stckles EA, Ominsky SH, Sollitto RA, Gavlin HB, Monticciolo DL. Medical audit of a rapid-throughput mammography screening practice: methodology and results of 27,114 examinations. Radiology. 1990;175:323–7.
Littrup PJ, Lee F, Mettlin C. Prostate cancer screening: current trends and future implications. CA Cancer J Clin. 1992;42:198–211.
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This work was supported by a grant from the Upjohn Company, Kalamazoo, Mich.
Gerald L. Klerman, MD, was the initial principal investigator on the SDDS-PC project until his death in 1992. W. Eugene Broadhead, MD, PhD, was principal investigator from 1992 to 1995. Roger Kathol, MD, is currently the principal investigator. The Upjohn Company, Kalamazoo, Mich., sponsored and supported the development of the SDDS-PC through its Pharmacosurveillance Unit, Mr. James A. Coleman, Director, and Andreas Pleil, PhD, Senior Health Economist. Drs. Leon, Olfson, Weissman, Blacklow, Broadhead, and Hoven have served as consultants to Upjohn. Allen Frances, MD (Duke University), and Michael Leibowitz, MD (Columbia University), provided advice, Carrie Miller, PhD, was project manager at Kaiser Permanente. Lena Verdeli, MA, MSc, trained the nurses and assisted in the coordinating of the QAP. Laura Portera assisted in data analysis, and Joy Pelayo assisted in data management. The participating physicians and nurses and the Scientific Advisory Committee members who met with investigators and provided input into the project are listed below.
Scientific Advisory Committee: Macaran Baird, MD, SUNY Health Science Center; Dave Baron, DO, American Osteopathic Association; Susan Blumenthal, MD, Assistant Surgeon General; Jorge A. Costa e Silva, World Health Organization; Leah Dickstein, MD, University of Louisville School of Medicine; Mary Jane England, MD, Washington Business Group on Health; Shervert H, Frazier, MD, McLean Hospital; Roman H, Hendrickson, MD, American Academy of Family Physicians; Norman B. Kahn, MD, American Academy of Family Physicians; Kathryn Magruder, PhD, National Institute of Health; Harold A. Pincus, MD, American Psychiatric Association; Darrell A. Regier, MD, MPH, National Institute of Mental Health; Rene Rodriguez, MD, National Confederation of Hispanic American Medical Association; Richard Rupper, MD, American Society of Internal Medicine; Norman Sartorius, MD, World Health Organization; Richard Steinhilber, MD, Cleveland Clinic Foundation; William Van Stone, MD, Department of Veteran Affairs; Elinor Walker, Agency for Health Care Policy and Research; and Paul Young, MD, American Board of Family Practice. Their presence on the Advisory Council in no way signifies an endorsement by these individuals or organizations.
SDDS-PC is a registered trademark of the Upjohn Company.
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Leon, A.C., Olfson, M., Weissman, M.M. et al. Brief screens for mental disorders in primary care. J Gen Intern Med 11, 426–430 (1996). https://doi.org/10.1007/BF02600191
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DOI: https://doi.org/10.1007/BF02600191