Validation and utility of a self-report version of PRIME-MD

R. L. Spitzer, K. Kroenke, J. B.W. Williams

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

The Primary Care Evaluation of Mental Disorders (PRIME-MD) arose as a screening instrument, but its clinical application has been restricted by its administration time. This criterion standard study was undertaken, between May 1997 and November 1998 to determine whether the self-administered PRIME-MD Patient Health Questionnaire (PHQ) is valid and useful for diagnosing mental disorders in primary care compared with the original clinician-administered -PRIME-M.D. Sixty-two primary care physicians (21 internal medicine, 41 family practice) assessed 3000 adult patients drawn from 8 U.S. primary care clinics. Of these, 585 patients were assessed by a mental health professional within 48 hours of completing the PHQ. Measures of outcome were PHQ diagnoses compared with diagnoses made independently by mental health practitioners, function status measures, disability days, health care utilization, and treatment/referral decisions. 825 (28%) of the 3000 patients and 170 (29%) of the 585 had a PHQ diagnosis. As with the original PRIME-MD, agreement between PHQ diagnoses and those made by mental health practitioners was good (for diagnosis of any 1 or more PHQ disorder, K = 0.65; overall accuracy, 85%; sensitivity, 75% specificity, 90%). Patients with PHQ diagnoses had more functional impairment and more disability days and used more-health care resources than did those without PHQ diagnoses (for all group main effects, p < .001). It took much less time, on average, for the physician to review the PHQ than to conduct the original PRIME-MD (< 3 min for 85% vs. 16% of the cases). In spite of the fact that 80% of physicians reported that they would find regular use of the PHQ helpful, new management actions were enacted or planned for only 117 (32%) of the 363 patients with 1 or more PHQ diagnoses previously unidentified. This study suggests that the PHQ has diagnostic validity equivalent to the original clinician-administered PRIME-MD while being more efficient to use.

Original languageEnglish (US)
Number of pages1
JournalPrimary Care Companion to the Journal of Clinical Psychiatry
Volume2
Issue number1
StatePublished - Dec 1 2000
Externally publishedYes

ASJC Scopus subject areas

  • Psychiatry and Mental health

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