title: A clinical predictive score for mood disorder risk in low-income primary care settings.
abstract: BACKGROUND
  Despite availability of validated screening tests for mood disorders, busy general practitioners (GPs) often lack the time to use them routinely. This study aimed to develop a simplified clinical predictive score to help screen for presence of current mood disorder in low-income primary care settings.
  
  
  METHODS
  In a cross-sectional study, 197 patients seen at 10 primary care centers in Santiago, Chile completed self-administered screening tools for mood disorders: the Patient Health questionnaire (PHQ-9) and the Mood Disorder Questionnaire (MDQ). To determine participants' current-point mood disorder status, trained clinicians applied a gold-standard diagnostic interview (SCID-I). A simplified clinical predictive model (CM) was developed based on clinical features and selected questions from the screening tools. Using CM, a clinical predictive score (PS) was developed. Full PHQ-9 and GP assessment were compared with PS.
  
  
  RESULTS
  Using multivariate logistic regression, clinical and demographic variables predictive of current mood disorder were identified for a simplified 8-point predictive score (PS). PS had better discrimination than GP assessment (auROC-statistic=0.80 [95% CI 0.72, 0.85] vs. 0.58 [95% CI 0.52, 0.62] p-value <0.0001), but not as good as the full PHQ-9 (0.89 [95% CI 0.85, 0.93], p-value=0.03). Compared with GP assessment, PS increased sensitivity by 50% at a fixed specificity of 90%. Administered in a typical primary care clinical population, it correctly predicted almost 80% of cases.
  
  
  CONCLUSIONS
  Further research must verify external validity of the PS.
  
  
  CONCLUSIONS
  An easily administered clinical predictive score determined, with reasonable accuracy, the current risk of mood disorders in low-income primary care settings.
authors.affiliation: Hospital Clínico Universidad de Chile, Unidad de Trastornos del Ánimo, Clínica Psiquiátrica Universitaria, Facultad Medicina, Universidad de Chile, Santiago, Chile; Mood Disorders Program, Tufts Medical Center, Boston, MA, United States; Tufts University School of Medicine, Boston, MA, United States; Graduate Program, Clinical and Translational Science Institute (CTSI), Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA, United States. Electronic address: PVohringer@tuftsmedicalcenter.org.
authors.forename: P A
authors.initials: PA
authors.lastname: Vöhringer
authors.forename: M I
authors.initials: MI
authors.lastname: Jimenez
authors.forename: M A
authors.initials: MA
authors.lastname: Igor
authors.forename: G A
authors.initials: GA
authors.lastname: Forés
authors.forename: M O
authors.initials: MO
authors.lastname: Correa
authors.forename: M C
authors.initials: MC
authors.lastname: Sullivan
authors.forename: N S
authors.initials: NS
authors.lastname: Holtzman
authors.forename: E A
authors.initials: EA
authors.lastname: Whitham
authors.forename: S A
authors.initials: SA
authors.lastname: Barroilhet
authors.forename: K
authors.initials: K
authors.lastname: Alvear
authors.forename: T
authors.initials: T
authors.lastname: Logvinenko
authors.forename: D M
authors.initials: DM
authors.lastname: Kent
authors.forename: S N
authors.initials: SN
authors.lastname: Ghaemi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis*; D011203:Poverty / Q000523:psychology*; D011320:Primary Health Care / Q000191:economics / Q000379:methods*; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Bipolar disorder; Depression; Diagnosis; Mood disorders; Primary health care; Screening