Psychiatric tool adds disorders, guidance to primary care screening

A new tool offers valid, efficient and feasible psychiatric screening in a primary care setting for depression, anxiety, bipolar disorder and post-traumatic stress disorder, researchers said.

Available screening tools focus on specific types of depression or anxiety and provide little guidance for management. Researchers studied the My Mood Monitor (M-3) checklist, a one-page tool to screen for four psychiatric disorders in primary care. Results were reported in the March Annals of Family Medicine.

The M-3 is a self-reported symptom checklist that asks whether the patient has experienced symptoms of major depressive disorder (7 questions), generalized anxiety disorder (2 questions), panic disorder (2 questions), social anxiety disorder (1 question), post-traumatic stress disorder (4 questions), and obsessive compulsive disorder (3 questions) during the past two weeks. It also asks about a lifetime history of symptoms of bipolar spectrum disorder (4 questions). At the end of the symptom checklist, the M-3 poses four functional impairment questions.

Researchers enrolled a sample of 647 consecutive participants aged 18 years and older who were seeking primary care at a single academic family medicine clinic between July 2007 and February 2008. The clinic's 55 clinicians saw 18,000 patients annually, with a mean age of 45.7 years, 60% of whom were women. Nearly two-thirds of clinic patients were white (63%); the rest were black (30%) or another ethnicity (7%). Participants completed the M-3 in the waiting room. Within 30 days, a research assistant administered the Mini International Neuropsychiatric Interview (MINI) to participating patients by telephone as a diagnostic standard.

The M-3 modules had sensitivities of at least 0.82 and specificities of at least 0.70 for bipolar disorder, anxiety and PTSD. As a screen for any psychiatric disorder, sensitivity was 0.83 and specificity was 0.76. At the end of the clinic visits, participants and their physicians completed questionnaires assessing the feasibility of use. Patients took less than five minutes to complete the M-3 in the waiting room, and less than 1% reported not having time to complete it. Eighty-three percent of clinicians reviewed the checklist in 30 or fewer seconds, and 80% thought it was helpful in reviewing patients' emotional health.

Guidelines suggest that depression screening should only be done in primary care settings that can then offer support or referral for care. Read more in the March issue of ACP Internist.