Feasibility and Diagnostic Validity of the M-3 Checklist: A Brief, Self-Rated Screen for Depressive, Bipolar, Anxiety, and Post-Traumatic Stress Disorders in Primary Care

Abstract

PURPOSE Mood and anxiety disorders are the most common psychiatric conditions seen in primary care, yet they remain underdetected and undertreated. Screening tools can improve detection, but available instruments are limited by the number of disorders assessed. We wanted to assess the feasibility and diagnostic validity of the My Mood Monitor (M-3) checklist, a new, 1-page, patient-rated, 27-item tool developed to screen for multiple psychiatric disorders in primary care. METHODSWe enrolled a sample of 647 consecutive participants aged 18 years and older who were seeking primary care at an academic family medicine clinic between July 2007 and February 2008. We used a 2-step scoring procedure to make screening more effi cient. The main outcomes measured were the sensitivity and specifi city of the M-3 for major depression, bipolar disorder, any anxiety disorder, and post-traumatic stress disorder (PTSD), a specifi c type of anxiety disorder. Using a split sample technique, analysis proceeded from determination of optimal screening thresholds to assessment of the psychometric properties of the self-report instrument using the determined thresholds. We used the Mini International Neuropsychiatric Interview as the diagnostic standard. Feasibility was assessed with patient and physician exit questionnaires. RESULTSThe depression module had a sensitivity of 0.84 and a specifi city of 0.80. The bipolar module had a sensitivity of 0.88, and a specifi city of 0.70. The anxiety module had a sensitivity of 0.82 and a specifi city of 0.78, and the PTSD module had a sensitivity of 0.88 and a specifi city of 0.76. As a screen for any psychiatric disorder, sensitivity was 0.83 and specifi city was 0.76. Patients took less than 5 minutes to complete the M-3 in the waiting room, and less than 1% reported not having time to complete it. Eighty-three percent of clinicians reviewed the checklist in 30 or fewer seconds, and 80% thought it was helpful in reviewing patients' emotional health.CONCLUSIONS The M-3 demonstrates utility as a valid, effi cient, and feasible tool for screening multiple common psychiatric illnesses, including bipolar disorder and PTSD, in primary care. Its diagnostic accuracy equals that of currently used single-disorder screens and has the additional benefi t of being combined into a 1-page tool. The M-3 potentially can reduce missed psychiatric diagnoses and facilitate proper treatment of identifi ed cases. prescriptions for mood and anxiety disorders in the United States, 3-5 underrecognition and inadequate treatment of these disorders in primary care practices remain substantial concerns. [5][6][7][8] Tools to improve the identifi cation and management of these disorders are therefore being developed to address this problem. [9][10][11] Despite these efforts, available tools narrowly focus on identifying either depressive or anxiety disorders and provide little guidance for management. Most screening tools target unipolar depression (16.1% prevalence), 12 and they do not help to differentiate unip...

Does This Patient Have Posttraumatic Stress Disorder?

“…No scale was difficult to administer, and even the longest could be completed by the vast majority of patients prior to their appointment. 72 Prevalence of PTSD Prevalence rates ascertained from gold standard diagnostic interviews for the 20 patient samples included in this report that contained information about prevalence range from 5% in a community primary care sample 73 to 35% in a sample of women receiving care at Veterans Health Administration facilities. 58 Based on diagnostic interviews, the random-effects summary estimate for prevalence of PTSD was 13.5% (95% CI, 5.0%-35.5%) in primary care studies, 58 We conducted 3 sensitivity analyses.…”

“…72 Both patients and physicians felt that screening facilitated discussion of mental health issues in the subsequent primary care encounter, and 80% of primary care physicians reported that the screen was helpful in interactions with their patients. 72 …”

Psychological Assessment in Psychopharmacology

“…Gaynes et al (2010) tested the My Mood Monitor (M-3) checklist, a patient-rated 27-item tool (Gaynes et al 2010). Using a sample of 647 consecutive primary care, the M-3 was examined against major depression, bipolar disorder, any anxiety disorder and post-traumatic stress disorder (PTSD) using the MINI.…”

Multidisciplinary Discourse

“…In a related comment on a different article, 9 an experienced measure developer 10 lauds the elegance and practicality of a parsimonious new instrument that screens for 4 common mental health disorders.…”