Detecting Mood Disorder in Resource-Limited Primary Care Settings: Comparison of a self-administered screening tool to general practitioner assessment. (September 2013)

• Record Type: Journal Article
• Authors: Vöhringer, Paul A; Jimenez, Mirtha I; Igor, Mirko A; Fores, Gonzalo A; Correa, Matias O; Sullivan, Matthew C; Holtzman, Niki S; Whitham, Elizabeth A; Barroilhet, Sergio A; Alvear, Katherine; Logvinenko, Tanya; Kent, David M; Ghaemi, Nassir S
• Is Part Of: Journal of medical screening. Volume 20:Number 3(2013)
• Page Start: 118
• Page End: 124
• Publication Date: 2013-09
• Subjects: Primary care -- Mental health -- Screening -- Depression -- Bipolar Disorder -- Mood Disorders; Medical screening -- Periodicals; 362.177
• DOI: 10.1177/0969141313503954
• Languages: English
• ISSNs: 0969-1413

Abstract

Objectives: Although efficacious treatments for mood disorders are available in primary care, under-diagnosis is associated with under-treatment and poorer outcomes. This study compares the accuracy of self-administered screening tests with routine general practitioner (GP) assessment for detection of current mood disorder. Methods: 197 consecutive patients attending primary care centres in Santiago, Chile enrolled in this cross-sectional study, filling out the Patients Health Questionnaire-9 (PHQ-9) for depression and the Mood Disorder Questionnaire (MDQ) for bipolar disorder, after routine GP assessment. Diagnostic accuracy of these self-administered tools was compared with GP assessment, with gold standard diagnosis established by a structured diagnostic interview with trained clinicians (SCID-I). Results: The sample was 75% female, with a mean age of 48.5 (SD 16.8); 37% had a current mood disorder (positive SCID-I result for depression or bipolar disorder). Sensitivity of the screening instruments (SI) was substantially higher than GP assessment (SI: 0.8, [95% CI 0.71, 0.81], versus GP: 0.2, [95% CI 0.12, 0.25]: p-value < 0.0001), without sacrifice in specificity (SI: 0.9, [95% CI 0.86, 0.96], versus GP: 0.9, [95% CI 0.88, 0.97]: p-value = 0.7). This led to improvement in both positive predictive value (SI: 0.8, [95% CI 0.82, 0.90], versus GP: 0.6, [95% CI 0.50, 0.64]: p-value < 0.001) and negative predictive value (SI: 0.9, [95% CI 0.78, 0.91] versus GP: 0.7, [95% CI 0.56, 0.72]: p-value < 0.01). Conclusion: Self-administered screening tools are more accurate than GP assessment in detecting current mood disorder in low-income primary care. Such screening tests may improve detection of current mood disorder if implemented in primary care settings.