1
|
Vöhringer PA, Jimenez MI, Igor MA, Forés GA, Correa MO, Sullivan MC, Holtzman NS, Whitham EA, Barroilhet SA, Alvear K, Logvinenko T, Kent DM, Ghaemi SN. A clinical predictive score for mood disorder risk in low-income primary care settings. J Affect Disord 2013; 151:1125-31. [PMID: 23916307 DOI: 10.1016/j.jad.2013.06.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 06/26/2013] [Indexed: 01/09/2023]
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. LIMITATIONS Further research must verify external validity of the PS. CONCLUSION An easily administered clinical predictive score determined, with reasonable accuracy, the current risk of mood disorders in low-income primary care settings.
Collapse
Affiliation(s)
- P A Vöhringer
- 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.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Vöhringer PA, Jimenez MI, Igor MA, Fores GA, Correa MO, Sullivan MC, Holtzman NS, Whitham EA, Barroilhet SA, Alvear K, Logvinenko T, Kent DM, Ghaemi NS. Detecting Mood Disorder in Resource-Limited Primary Care Settings: Comparison of a self-administered screening tool to general practitioner assessment. J Med Screen 2013; 20:118-24. [DOI: 10.1177/0969141313503954] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Although efficacious treatments for mood disorders are available in primary care, under-diagnosis is associated with under-treatment and poorer outcomes. This study compares the accuracy of self-administered screening tests with routine general practitioner (GP) assessment for detection of current mood disorder. Methods 197 consecutive patients attending primary care centres in Santiago, Chile enrolled in this cross-sectional study, filling out the Patients Health Questionnaire-9 (PHQ-9) for depression and the Mood Disorder Questionnaire (MDQ) for bipolar disorder, after routine GP assessment. Diagnostic accuracy of these self-administered tools was compared with GP assessment, with gold standard diagnosis established by a structured diagnostic interview with trained clinicians (SCID-I). Results The sample was 75% female, with a mean age of 48.5 (SD 16.8); 37% had a current mood disorder (positive SCID-I result for depression or bipolar disorder). Sensitivity of the screening instruments (SI) was substantially higher than GP assessment (SI: 0.8, [95% CI 0.71, 0.81], versus GP: 0.2, [95% CI 0.12, 0.25]: p-value < 0.0001), without sacrifice in specificity (SI: 0.9, [95% CI 0.86, 0.96], versus GP: 0.9, [95% CI 0.88, 0.97]: p-value = 0.7). This led to improvement in both positive predictive value (SI: 0.8, [95% CI 0.82, 0.90], versus GP: 0.6, [95% CI 0.50, 0.64]: p-value < 0.001) and negative predictive value (SI: 0.9, [95% CI 0.78, 0.91] versus GP: 0.7, [95% CI 0.56, 0.72]: p-value < 0.01). Conclusion Self-administered screening tools are more accurate than GP assessment in detecting current mood disorder in low-income primary care. Such screening tests may improve detection of current mood disorder if implemented in primary care settings.
Collapse
Affiliation(s)
- Paul A Vöhringer
- 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
- Graduate Program, Clinical and Translational Science Institute (CTSI), Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA, United States
| | - Mirtha I Jimenez
- Hospital Clínico Universidad de Chile, Unidad de Trastornos del Ánimo, Clínica Psiquiátrica Universitaria. Facultad Medicina, Universidad de Chile, Santiago, Chile
| | - Mirko A Igor
- Hospital Clínico Universidad de Chile, Unidad de Trastornos del Ánimo, Clínica Psiquiátrica Universitaria. Facultad Medicina, Universidad de Chile, Santiago, Chile
| | | | - Matias O Correa
- Departamento Psiquiatría, Facultad Medicina, Universidad de los Andes, Santiago, Chile
| | | | | | | | - Sergio A Barroilhet
- Escuela de Psicología, Universidad de los Andes, Santiago, Chile
- Mood Disorders Program, Tufts Medical Center, Boston, MA
| | | | - Tanya Logvinenko
- Biostatistics Research Center at the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - David M Kent
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Nassir S Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA
- Tufts University School of Medicine
| |
Collapse
|