Outcome and Impact of Mental Disorders in Primary Care at 5 years

Jackson, Jeffrey L.; Passamonti, Mark; Kroenke, Kurt

doi:10.1097/psy.0b013e3180314b59

Cited by 70 publications

(56 citation statements)

References 57 publications

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“…It is likely that diagnostic accuracy will vary according to the number of contacts. Few studies have been designed to account for this [20,78,79]. In the studies of late-life depression that examined cumulative rather than cross-sectional detection over 6 [35,80] or 12 months [81], there was no appreciable additional effect on recognition, although the data were limited.…”

Section: Discussionmentioning

confidence: 99%

Do Primary Care Physicians Have Particular Difficulty Identifying Late-Life Depression? A Meta-Analysis Stratified by Age

Mitchell

Rao

Vaze

2010

Psychother Psychosom

125

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Background: There is long-standing concern regarding poor recognition of depression in primary care, especially in older people. Methods: Studies that examined the unassisted (clinical) ability of general practitioners (GPs; primary care physicians) to identify depression were divided into those of older adults, younger adults and mixed populations. Data were extracted by 3 reviewers independently and pooled using a Bayesian meta-analysis. Results: We identified 31 valid studies that examined both sensitivity and specificity (or rule-in and rule-out accuracy), involving 52,513 individuals. Twelve studies recruited older individuals, 12 recruited younger adults and 7 recruited both younger and older adults (mixed populations). In the most robust studies the point prevalence of depression in late life was 13.2% (95% CI = 7.9–19.6). GPs were able to correctly identify 47.3% of the late-life depressions and 78.6% of the non-cases (71.0% overall accuracy). In younger adults GPs were able to identify 39.7% of the mid-life depressions and 85.1% of the non-depressed (77.8% overall accuracy). In mixed aged groups GPs we able to correctly identify 46.6% of the depressed individuals and 86.2% of the non-depressed (79.6% overall accuracy). The overall fraction correctly identified was significantly lower in older compared with younger adults. Correcting for differences in prevalence showed a statistically lower rule-in performance for older compared with younger adults. There was no difference in ability to identify non-depressed (healthy) individuals by age. Conclusions: In clinical practice GPs appear to be less successful in identifying depression in older people than in younger adults, however there have been few head-to-head studies stratified by age from one centre.

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Section: Discussionmentioning

confidence: 99%

Do Primary Care Physicians Have Particular Difficulty Identifying Late-Life Depression? A Meta-Analysis Stratified by Age

Mitchell

Rao

Vaze

2010

Psychother Psychosom

125

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“…1,2 Although primary care physicians account for most mental health visits and write the bulk of antidepressant and antianxiety…”

Section: Introductionmentioning

confidence: 99%

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

Gaynes

DeVeaugh-Geiss²,

Weir

et al. 2010

The Annals of Family Medicine

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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...

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“…Other one-year follow-up studies of patients who screened positive for depression have had similar results (42–45). Adverse outcomes among patients who screen positive for depression have been documented in a 45-month follow-up study of older primary care patients (20), a five-year follow-up study at Walter Reed Army Medical Center (24), and a seven-year follow-up study from Finland (25). However, some short-term follow-up studies of six to 12 months have reported that undetected mild depression resolves without intervention (20).…”

Section: Discussionmentioning

confidence: 99%

Positive Screens for Psychiatric Disorders in Primary Care: A Long-Term Follow-Up of Patients Who Were Not in Treatment

Weissman¹,

Neria²,

Gameroff³

et al. 2010

Psychiatric Services

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Objective Screening for psychiatric disorders has gained acceptance in some general medical settings, but critics argue about its value. The purpose of this study was to determine the clinical utility of screening by conducting a long-term follow-up of patients who screened positive for psychiatric disorders but who were initially not in treatment. Methods A cohort of 519 low-income, adult primary care patients were screened for major depression and bipolar, anxiety, and substance use disorders and reassessed with the Structured Clinical Interview for DSM-IV after a mean of 3.7 years by a clinician blind to the initial screen. Data on treatment utilization was obtained through hospital records. The sample consisted of 348 patients who had not received psychiatric care in the year before screening. Results Among 39 patients who screened positive for major depression, 62% (95% confidence interval=45.5%–77.6%) met criteria for current major depressive disorder at follow-up. Those who screened positive reported significantly poorer mental and social functioning and worse general health at follow-up than the screen-negative patients and were more likely to have visited the emergency department for psychiatric reasons (12.1% and 3.0%, odds ratio [OR]=6.4) and to have major depression (OR=7.6). Generally similar results were observed for patients who screened positive for other disorders. Conclusions Commonly used screening methods identified patients with psychiatric disorders; about four years later, those not initially in treatment were likely to have enduring symptoms and to use emergency psychiatric services. Screening should be followed up by clinical diagnostic assessment in the context of available mental health treatment.

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Outcome and Impact of Mental Disorders in Primary Care at 5 years

Abstract: Mental disorders are common and their recognition and treatment remain low. Subthreshold disorders have a better prognosis. Patients with threshold or multiple disorders, worse functioning or persistence of their disorder were more likely to be diagnosed.

Cited by 70 publications

References 57 publications

Do Primary Care Physicians Have Particular Difficulty Identifying Late-Life Depression? A Meta-Analysis Stratified by Age

Do Primary Care Physicians Have Particular Difficulty Identifying Late-Life Depression? A Meta-Analysis Stratified by Age

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

Positive Screens for Psychiatric Disorders in Primary Care: A Long-Term Follow-Up of Patients Who Were Not in Treatment

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