Related Experiment Video
Updated: Aug 13, 2026
Association Between Sleep Quality and Cognitive Symptoms in Patients with Major Depressive Disorder
Published on: April 26, 2024
The detection of depression in medical setting: a study with PRIME-MD
Renerio Fraguas1, Sergio Gonsalves Henriques, Sergio Gonsalves Henriques
1Department and Institute of Psychiatry, Faculty of Medicine, University of Sao Paulo, Brazil. rfraguas@partners.org
Background:
Studies investigating the performance of instruments to detect major depressive disorder (MDD) have reported inconsistent results. Subsyndromal depression (SD) has also been associated to increased morbidity, and little is known about its detection in primary care setting. This study aimed to investigate the performance of the Primary Care Evaluation of Mental Disorders (PRIME-MD) to detect MDD and any depression (threshold at SD) in an outpatient unit of a teaching general hospital.
Methods:
Nineteen primary care physicians using the PRIME-MD evaluated 577 patients, 240 of them (75% female; mean age, 40.0 +/- 14.4), including all with MDD and a randomly subset of those without MDD, were evaluated by 11 psychiatrists using the Structured Clinical Interview Axis I Disorders, Patient Version (SCIDI/P) for DSM-IV as the standard instrument.
Results:
The kappa between the PRIME-MD and the SCID was 0.42 for the diagnosis of any depression and 0.32 for MDD. The distribution of the number of depressive symptoms per patient suggested the existence of a continuum between SD and MDD, and a high frequency of subjects with 4-6 symptoms (close to the cutoff for the diagnosis of MDD).
Limitations:
The sample has a modest size and is a subset of an original one.
Conclusion:
A continuum between SD and MDD may in part explain the relatively low agreement for the diagnosis of MDD in our sample and possibly in other studies. Studies investigating the performance of screening instruments to detect MDD, should consider the relevance of identifying SD, and the influence of the distribution of the number of depressive symptoms in their results.
Insights
The Primary Care Evaluation of Mental Disorders (PRIME-MD) showed modest agreement in detecting major depressive disorder (MDD) and any depression. A continuum between subsyndromal depression (SD) and MDD may influence diagnostic accuracy in primary care.
Area of Science:
- Mental Health
- Clinical Psychology
- Psychiatry
Background:
- Inconsistent results exist regarding instruments for detecting major depressive disorder (MDD).
- Subsyndromal depression (SD) is linked to increased morbidity, with limited data on its detection in primary care.
- This study addresses the performance of the Primary Care Evaluation of Mental Disorders (PRIME-MD) for detecting MDD and any depression.
Purpose of the Study:
- To evaluate the diagnostic performance of the PRIME-MD in identifying major depressive disorder (MDD) and any depression (including subsyndromal depression).
- To assess the utility of a mental health screening tool in a primary care setting.
Main Methods:
- 19 primary care physicians utilized the PRIME-MD on 577 patients.
- A subset of 240 patients was independently assessed by 11 psychiatrists using the Structured Clinical Interview for DSM-IV (SCID).
- The SCID served as the gold standard for comparison.
Main Results:
- Kappa agreement was 0.42 for any depression and 0.32 for MDD between PRIME-MD and SCID.
- A continuum of depressive symptoms was observed, with many patients near the MDD diagnostic threshold.
- This suggests a potential overlap between subsyndromal depression and MDD.
Conclusions:
- The observed continuum between subsyndromal depression and MDD may explain the modest agreement in MDD diagnosis.
- Future studies on MDD screening should consider the identification of SD and symptom distribution.
- The PRIME-MD's performance in this primary care setting warrants further investigation.
Related Concept Videos
01:18Depression: Overview
01:27Depressive Disorders: MDD and Dysthymia