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1: JAMA. 1994 Dec 14;272(22):1749-56.
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Comment in:
  • ACP J Club. 1995 May-Jun;122(3):73.

Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study.

Spitzer RL, Williams JB, Kroenke K, Linzer M, deGruy FV 3rd, Hahn SR, Brody D, Johnson JG.

Biometrics Research Department, New York State Psychiatric Institute, NY 10032.

OBJECTIVE--To assess the validity and utility of PRIME-MD (Primary Care Evaluation of Mental Disorders), a new rapid procedure for diagnosing mental disorders by primary care physicians. DESIGN--Survey; criterion standard. SETTING--Four primary care clinics. SUBJECTS--A total of 1000 adult patients (369 selected by convenience and 631 selected by site-specific methods to avoid sampling bias) assessed by 31 primary care physicians. MAIN OUTCOME MEASURES--PRIME-MD diagnoses, independent diagnoses made by mental health professionals, functional status measures (Short-Form General Health Survey), disability days, health care utilization, and treatment/referral decisions. RESULTS--Twenty-six percent of the patients had a PRIME-MD diagnosis that met full criteria for a specific disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. The average time required of the primary care physician to complete the PRIME-MD evaluation was 8.4 minutes. There was good agreement between PRIME-MD diagnoses and those of independent mental health professionals (for the diagnosis of any PRIME-MD disorder, kappa = 0.71; overall accuracy rate = 88%). Patients with PRIME-MD diagnoses had lower functioning, more disability days, and higher rates of health care utilization than did patients without PRIME-MD diagnoses (for all measures, P < .005). Nearly half (48%) of 287 patients with a PRIME-MD diagnosis who were somewhat or fairly well-known to their physicians had not been recognized to have that diagnosis before the PRIME-MD evaluation. A new treatment or referral was initiated for 62% of the 125 patients with a PRIME-MD diagnosis who were not already being treated. CONCLUSION--PRIME-MD appears to be a useful tool for identifying mental disorders in primary care practice and research.

PMID: 7966923 [PubMed - indexed for MEDLINE]