Patients with HIV infection and mental illness: a study of clinical identification

We compared provider diagnosis of mental illness as noted in a chart audit to an indication of mental illness using the Revised Symptom Checklist (SCL-90R). We identified cases of correct diagnoses, over-diagnoses, and missed diagnoses of mental illness by examining mental functioning (using the SF-36). Providers over diagnosed mental illness in 23% of the cases and missed a diagnosis in 9% of the cases. The over-diagnosed group had significantly better mental functioning and the missed-diagnosis group did not have better mental functioning than those who the provider and SCL-90 agreed had mental illness. The SCL-90R had a higher correlation with mental functioning than did the providers' diagnoses, suggesting that such instruments may increase the correct detection of mental illness in the HIV population.