David P Goldberg1, Geoffrey M Reed2, Rebeca Robles3, Fareed Minhas4, Bushra Razzaque4, Sandra Fortes5, Jair de Jesus Mari6, Tai Pong Lam7, José Ángel Garcia3, Linda Gask8, Anthony C Dowell9, Marianne Rosendal10, Joseph K Mbatia11, Shekhar Saxena12. 1. Institute of Psychiatry, King's College London, United Kingdom. Electronic address: davidpgoldberg@yahoo.com. 2. World Health Organization, Geneva, Switzerland; Global Mental Health Program, Columbia University Medical Center, New York, NY, USA. 3. National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico. 4. Institute of Psychiatry, Rawalpindi, Pakistan. 5. Rio de Janeiro State University, Rio de Janeiro, Brazil. 6. Federal University of São Paulo, São Paulo, Brazil. 7. University of Hong Kong, Hong Kong, People's Republic of China. 8. University of Manchester, Manchester, United Kingdom. 9. University of Otago, Wellington, New Zealand. 10. Research Unit for General Practice, University of Southern Denmark, Odense, Denmark. 11. Sebastian Kolowa Memorial University, Lushoto, Tanzania. 12. World Health Organization, Geneva, Switzerland.
Abstract
BACKGROUND: In this field study of WHO's revised classification of mental disorders for primary care settings, the ICD-11 PHC, we tested the usefulness of two five-item screening scales for anxiety and depression to be administered in primary care settings. METHODS: The study was conducted in primary care settings in four large middle-income countries. Primary care physicians (PCPs) referred individuals who they suspected might be psychologically distressed to the study. Screening scales as well as a structured diagnostic interview, the revised Clinical Interview Schedule (CIS-R), adapted for proposed decision rules in ICD-11 PHC, were administered to 1488 participants. RESULTS: A score of 3 or more on one or both screening scale predicted 89.6% of above-threshold mood or anxiety disorder diagnoses on the CIS-R. Anxious depression was the most common CIS-R diagnosis among referred patients. However, there was an exact diagnostic match between the screening scales and the CIS-R in only 62.9% of those with high scores. LIMITATIONS: This study was confined to those in whom the PCP suspected psychological distress, so does not provide information about the prevalence of mental disorders in primary care settings. CONCLUSIONS: The two five-item screening scales for anxiety and depression provide a practical way for PCPs to evaluate the likelihood of mood and anxiety disorders without paper and pencil measures that are not feasible in many settings. These scales may provide substantially improved case detection as compared to current primary care practice and a realistic alternative to complex diagnostic algorithms used by specialist mental health professionals.
BACKGROUND: In this field study of WHO's revised classification of mental disorders for primary care settings, the ICD-11 PHC, we tested the usefulness of two five-item screening scales for anxiety and depression to be administered in primary care settings. METHODS: The study was conducted in primary care settings in four large middle-income countries. Primary care physicians (PCPs) referred individuals who they suspected might be psychologically distressed to the study. Screening scales as well as a structured diagnostic interview, the revised Clinical Interview Schedule (CIS-R), adapted for proposed decision rules in ICD-11 PHC, were administered to 1488 participants. RESULTS: A score of 3 or more on one or both screening scale predicted 89.6% of above-threshold mood or anxiety disorder diagnoses on the CIS-R. Anxious depression was the most common CIS-R diagnosis among referred patients. However, there was an exact diagnostic match between the screening scales and the CIS-R in only 62.9% of those with high scores. LIMITATIONS: This study was confined to those in whom the PCP suspected psychological distress, so does not provide information about the prevalence of mental disorders in primary care settings. CONCLUSIONS: The two five-item screening scales for anxiety and depression provide a practical way for PCPs to evaluate the likelihood of mood and anxiety disorders without paper and pencil measures that are not feasible in many settings. These scales may provide substantially improved case detection as compared to current primary care practice and a realistic alternative to complex diagnostic algorithms used by specialist mental health professionals.
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Authors: Carolina Ziebold; David P Goldberg; Geoffrey M Reed; Fareed Minhas; Bushra Razzaque; Sandra Fortes; Rebeca Robles; Tai Pong Lam; Julio Bobes; Celso Iglesias; Hugo Cogo-Moreira; José Ángel García; Jair J Mari Journal: Psychol Med Date: 2018-06-04 Impact factor: 7.723
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