title: Screening for anxiety, depression, and anxious depression in primary care: A field study for ICD-11 PHC.
abstract: In this field study of WHO's revised classification of mental disorders for primary care settings, the ICD-11 PHC, we tested the usefulness of two five-item screening scales for anxiety and depression to be administered in primary care settings.
  
  
  
  The study was conducted in primary care settings in four large middle-income countries. Primary care physicians (PCPs) referred individuals who they suspected might be psychologically distressed to the study. Screening scales as well as a structured diagnostic interview, the revised Clinical Interview Schedule (CIS-R), adapted for proposed decision rules in ICD-11 PHC, were administered to 1488 participants.
  
  
  
  A score of 3 or more on one or both screening scale predicted 89.6% of above-threshold mood or anxiety disorder diagnoses on the CIS-R. Anxious depression was the most common CIS-R diagnosis among referred patients. However, there was an exact diagnostic match between the screening scales and the CIS-R in only 62.9% of those with high scores.
  
  
  
  This study was confined to those in whom the PCP suspected psychological distress, so does not provide information about the prevalence of mental disorders in primary care settings.
  
  
  
  The two five-item screening scales for anxiety and depression provide a practical way for PCPs to evaluate the likelihood of mood and anxiety disorders without paper and pencil measures that are not feasible in many settings. These scales may provide substantially improved case detection as compared to current primary care practice and a realistic alternative to complex diagnostic algorithms used by specialist mental health professionals.
authors.affiliation: Institute of Psychiatry, King's College London, United Kingdom. Electronic address: davidpgoldberg@yahoo.com.
authors.forename: David P
authors.initials: DP
authors.lastname: Goldberg
authors.affiliation: World Health Organization, Geneva, Switzerland; Global Mental Health Program, Columbia University Medical Center, New York, NY, USA.
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Reed
authors.affiliation: National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Robles
authors.affiliation: Institute of Psychiatry, Rawalpindi, Pakistan.
authors.forename: Fareed
authors.initials: F
authors.lastname: Minhas
authors.affiliation: Institute of Psychiatry, Rawalpindi, Pakistan.
authors.forename: Bushra
authors.initials: B
authors.lastname: Razzaque
authors.affiliation: Rio de Janeiro State University, Rio de Janeiro, Brazil.
authors.forename: Sandra
authors.initials: S
authors.lastname: Fortes
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Jair de Jesus
authors.initials: JJ
authors.lastname: Mari
authors.affiliation: University of Hong Kong, Hong Kong, People's Republic of China.
authors.forename: Tai Pong
authors.initials: TP
authors.lastname: Lam
authors.affiliation: National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico.
authors.forename: José Ángel
authors.initials: JÁ
authors.lastname: Garcia
authors.affiliation: University of Manchester, Manchester, United Kingdom.
authors.forename: Linda
authors.initials: L
authors.lastname: Gask
authors.affiliation: University of Otago, Wellington, New Zealand.
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Dowell
authors.affiliation: Research Unit for General Practice, University of Southern Denmark, Odense, Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Rosendal
authors.affiliation: Sebastian Kolowa Memorial University, Lushoto, Tanzania.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Mbatia
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Shekhar
authors.initials: S
authors.lastname: Saxena
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis*; D003866:Depressive Disorder / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales / Q000592:standards; D011594:Psychometrics / Q000295:instrumentation*; D013315:Stress, Psychological / Q000175:diagnosis
keywords: Anxiety; Depression; ICD-11; Primary care; Screening