Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study.
OBJECTIVE
To assess the validity and utility of PRIME-MD (Primary Care Evaluation of Mental Disorders), a new rapid procedure for diagnosing mental disorders by primary care physicians.


METHODS
Survey; criterion standard.


METHODS
Four primary care clinics.


METHODS
A total of 1000 adult patients (369 selected by convenience and 631 selected by site-specific methods to avoid sampling bias) assessed by 31 primary care physicians.


METHODS
PRIME-MD diagnoses, independent diagnoses made by mental health professionals, functional status measures (Short-Form General Health Survey), disability days, health care utilization, and treatment/referral decisions.


RESULTS
Twenty-six percent of the patients had a PRIME-MD diagnosis that met full criteria for a specific disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. The average time required of the primary care physician to complete the PRIME-MD evaluation was 8.4 minutes. There was good agreement between PRIME-MD diagnoses and those of independent mental health professionals (for the diagnosis of any PRIME-MD disorder, kappa = 0.71; overall accuracy rate = 88%). Patients with PRIME-MD diagnoses had lower functioning, more disability days, and higher rates of health care utilization than did patients without PRIME-MD diagnoses (for all measures, P < .005). Nearly half (48%) of 287 patients with a PRIME-MD diagnosis who were somewhat or fairly well-known to their physicians had not been recognized to have that diagnosis before the PRIME-MD evaluation. A new treatment or referral was initiated for 62% of the 125 patients with a PRIME-MD diagnosis who were not already being treated.


CONCLUSIONS
PRIME-MD appears to be a useful tool for identifying mental disorders in primary care practice and research.
Spitzer
R L
RL
Biometrics Research Department, New York State Psychiatric Institute, NY 10032.
Williams
J B
JB
Kroenke
K
K
Linzer
M
M
deGruy
F V
FV
Hahn
S R
SR
Brody
D
D
Johnson
J G
JG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003953:Diagnosis-Related Groups; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011570:Psychiatry; D011584:Psychology; D015203:Reproducibility of Results