Development and validation of the SDDS-PC screen for multiple mental disorders in primary care
W. E. Broadhead, A. C. Leon, M. M. Weissman, J. E. Barrett, R. S. Blacklow, T. T. Gilbert, M. B. Keller, M. Olfson and E. S. Higgins
Duke University Medical Center, Durham, NC.
OBJECTIVE: To develop, validate, and cross-validate a patient-completed
screen for multiple mental disorders in primary care. DESIGN: Comparison of
a patient self-report screen with an independent diagnostic assessment by
mental health professionals using the Structured Clinical Interview for
DSM-III-R diagnoses as criterion standard. SETTING: Three Rhode Island
family practices and a South Carolina family medicine residency. SUBJECTS:
In the initial validation study, 937 patients in Rhode Island were
screened; 388 were interviewed. In the cross-validation study, 775 patients
were screened in Rhode Island and South Carolina, and 257 were interviewed.
SCREEN ITEMS: Sixty-two questions pertaining to nine mental disorders and
suicidal ideation. RESULTS: A 16-item screen remained after analysis of
item and scale performance. Sensitivity, specificity, and positive
predictive value, respectively, were calculated for the following scales:
alcohol abuse or dependence (62%, 98%, and 54%), generalized anxiety
disorder (90%, 54%, and 5%), major depression (90%, 77%, and 40%),
obsessive-compulsive disorder (65%, 73%, and 5%), panic disorder (78%, 80%,
and 21%), and suicidal ideation (43%, 91%, and 51%). Replication in a new
sample showed attenuated but acceptable operating characteristics for
cross-validation. CONCLUSIONS: The Symptom-Driven Diagnostic System for
Primary Care screen assesses multiple mental disorders that are common to
primary care. It serves as a sensitive, valid, and patient-friendly first
step in a new approach to recognizing and managing mental disorders in
primary care. Finally, it aids the primary care clinician in selecting an
appropriate diagnostic interview module for the disease for which the
patient screened positive.
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