Development and validation of the SDDS-PC screen for multiple mental disorders in primary care.
OBJECTIVE
To develop, validate, and cross-validate a patient-completed screen for multiple mental disorders in primary care.


METHODS
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.


METHODS
Three Rhode Island family practices and a South Carolina family medicine residency.


METHODS
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.
Broadhead
W E
WE
Duke University Medical Center, Durham, NC.
Leon
A C
AC
Weissman
M M
MM
Barrett
J E
JE
Blacklow
R S
RS
Gilbert
T T
TT
Keller
M B
MB
Olfson
M
M
Higgins
E S
ES
D000328:Adult; D003937:Diagnosis, Differential; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011581:Psychological Tests / Q000592:standards; D012680:Sensitivity and Specificity