Brief diagnostic interviews (SDDS-PC) for multiple mental disorders in primary care. A pilot study
M. M. Weissman, M. Olfson, A. C. Leon, W. E. Broadhead, T. T. Gilbert, E. S. Higgins, J. E. Barrett, R. S. Blacklow, M. B. Keller and C. Hoven
College of Physicians and Surgeons of Columbia University, New York, NY.
OBJECTIVE: To pilot test the feasibility and validity of new, brief,
structured, physician-administered diagnostic interviews for six mental
disorders in primary care patients identified from a patient-completed
screen. DESIGN: Comparison of the new diagnostic interviews with the
Structured Clinical Interview for the Diagnostic and Statistical Manual of
Mental Disorders, Revised Third Edition, version P (SCID-P), administered
independently by a mental health professional. SETTING: Three Rhode Island
family practices and a South Carolina family medicine residency. SUBJECTS:
Consecutive patients of either sex, aged 18 to 70 years, who were able to
read and write English were eligible for screening; 775 patients completed
the screen. Of these, 246 screened positive for at least one disorder and
received at least one module. Of these, 158 received a SCID-P interview.
RESULTS: The diagnostic interviews were found useful by all 16
participating physicians. Eighty-seven percent reported that they diagnosed
a new mental problem, and 93% said that the modules clarified suspected
symptoms. However, 26% thought the procedure was too time consuming, and
80% believed that reimbursement would be necessary for routine use.
Detection of cases using the diagnostic modules was associated with
physician intervention and with independent assessment of patient
impairment. Over three quarters of the patients (76.4%) who were classified
as positive by the physician interview for any of the diagnoses also tested
positive on the SCID-P. Two thirds of the patients (62.7%) with at least
one of the disorders (according to SCID-P) were classified by the physician
interview as having a mental disorder. However, the operating
characteristics varied across specific disorders and indicated a need for
revisions and testing in larger samples. CONCLUSIONS: These brief
physician-administered diagnostic interview modules are part of a screening
and diagnostic system (Symptom-Driven Diagnostic System for Primary Care
[SDDS-PC], The UpJohn Co, Kalamazoo, Mich) to detect mental disorders in
primary care patients. The pilot results help establish their feasibility
and validity.
