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[Can we detect mental disorders in primary care? Usefulness and agreement of 2 diagnostic instruments]
R Martínez Bernardos1, A Baylín Larios, M F Ortiz Jiménez
1Centro de Salud Luis Vives (EAP Luis Vives I), Alcalá de Henares Madrid. csluisvives@meditex.es
Objectives:
The main objective was to evaluate the use of two diagnostic instruments for mental disorders in primary care (PC): the PRIME-MD and the Goldberg anxiety and depression scales. Second, to determine the concordance between the two tests and evaluate the quality of psychiatric diagnosis records in the clinical notes.
Design:
Crossover observational study.
Setting:
Luis Vives Health Centre (EAP 1), Alcalá de Henares (Madrid).
Patients:
175 patients who attended for consultation on-demand over three months.
Measurements And Main Results:
Each patient was given the PRIME-MD test for detecting disorders of depression, anxiety, food, alcohol and body form; and the Goldberg scale to evaluate anxiety and depression. The clinical records were then reviewed for previous psychiatric diagnoses. The two scales were compared and the level of concordance obtained. The PRIME-MD found that 78 patients (44.6%) had some mental disorder, the most frequent being depression (32.6% of the total). The Goldberg scale detected 89 patients (50.8%) with some suspected mental disorder: here too, the most common was depression (41.7% of the total). The best indication of concordance between the two tests was the diagnosis of anxiety disorders: kappa = 0.68 (CI 95%, 0.53-0.82).
Conclusions:
Both scales seem useful instruments for detecting a pathology which is very common in PC clinics: mental disorders. Moreover, the concordance between the two scales is acceptable. There was poor recording of psychiatric diagnoses in clinical records.