We evaluated a set of diagnostic screens for mental disorders in primary care. A self-administered screening questionnaire
containing 26 items testing for multiple mental disorders was completed by 1,001 patients. Brief diagnostic modules, structured
for psychiatric diagnoses, were subsequently administered to each patient by a research nurse. Operating characteristics of
the screens were as follows: alcohol dependence (sensitivity [SE] 0.75; positive predictive value [PPV] 0.58; [κ] 0.63), drug
dependence (SE 0.50; PPV 0.50; κ 0.50), generalized anxiety disorder (SE 0.74; PPV 0.44; κ 0.44), major depressive disorder
(SE 0.71; PPV 0.52; κ 0.50), obsessive compulsive disorder (SE 0.71; PPV 0.15; κ 0.21), and panic disorder (SE 0.71; PPV 0.43;
κ 0.48). Other chance-corrected measures of agreement are also reported, and criterion validity of the screens is examined.
The results provide evidence that the screens discriminate between patients with symptomatology meeting established diagnostic
criteria and those without. They detected previously unrecognized cases in this study and may prove to be valuable tools for
psychiatric diagnosis in primary care.
Key words mental disorders - diagnostic screens - primary care - brief screens - operating characteristics
This work was supported by a grant from the Upjohn Company, Kalamazoo, Mich.
Gerald L. Klerman, MD, was the initial principal investigator on the SDDS-PC project until his death in 1992. W. Eugene Broadhead,
MD, PhD, was principal investigator from 1992 to 1995. Roger Kathol, MD, is currently the principal investigator. The Upjohn
Company, Kalamazoo, Mich., sponsored and supported the development of the SDDS-PC through its Pharmacosurveillance Unit, Mr.
James A. Coleman, Director, and Andreas Pleil, PhD, Senior Health Economist. Drs. Leon, Olfson, Weissman, Blacklow, Broadhead,
and Hoven have served as consultants to Upjohn. Allen Frances, MD (Duke University), and Michael Leibowitz, MD (Columbia University),
provided advice, Carrie Miller, PhD, was project manager at Kaiser Permanente. Lena Verdeli, MA, MSc, trained the nurses and
assisted in the coordinating of the QAP. Laura Portera assisted in data analysis, and Joy Pelayo assisted in data management.
The participating physicians and nurses and the Scientific Advisory Committee members who met with investigators and provided
input into the project are listed below.
Scientific Advisory Committee: Macaran Baird, MD, SUNY Health Science Center; Dave Baron, DO, American Osteopathic Association; Susan Blumenthal, MD, Assistant
Surgeon General; Jorge A. Costa e Silva, World Health Organization; Leah Dickstein, MD, University of Louisville School of
Medicine; Mary Jane England, MD, Washington Business Group on Health; Shervert H, Frazier, MD, McLean Hospital; Roman H, Hendrickson,
MD, American Academy of Family Physicians; Norman B. Kahn, MD, American Academy of Family Physicians; Kathryn Magruder, PhD,
National Institute of Health; Harold A. Pincus, MD, American Psychiatric Association; Darrell A. Regier, MD, MPH, National
Institute of Mental Health; Rene Rodriguez, MD, National Confederation of Hispanic American Medical Association; Richard Rupper,
MD, American Society of Internal Medicine; Norman Sartorius, MD, World Health Organization; Richard Steinhilber, MD, Cleveland
Clinic Foundation; William Van Stone, MD, Department of Veteran Affairs; Elinor Walker, Agency for Health Care Policy and
Research; and Paul Young, MD, American Board of Family Practice. Their presence on the Advisory Council in no way signifies
an endorsement by these individuals or organizations.
SDDS-PC is a registered trademark of the Upjohn Company.