A comparison of three psychiatric screening tests using receiver operating characteristic (ROC) analysis

Area of Science:

• Psychiatry
• Primary Care Medicine
• Psychometrics

Background:

• Primary care physicians require effective tools for detecting undiagnosed mental health conditions.
• Screening questionnaires aid in identifying depression and anxiety disorders in non-specialist settings.

Purpose of the Study:

• To evaluate the diagnostic accuracy of three self-administered screening questionnaires: the General Health Questionnaire (GHQ), Mental Health Inventory (MHI), and Somatic Symptom Inventory (SSI).
• To compare the performance of GHQ, MHI, and SSI in detecting psychiatric disorders, particularly anxiety and affective disorders, using the Diagnostic Interview Schedule (DIS) as a gold standard.

Main Methods:

• Receiver Operating Characteristic (ROC) analysis was employed to assess the performance of the GHQ, MHI, and SSI.
• 364 health maintenance organization (HMO) members underwent screening with GHQ, MHI, SSI, and a DIS interview for psychiatric diagnosis.
• Participants were stratified based on preliminary GHQ results.

Main Results:

• The MHI demonstrated superior performance over the GHQ in detecting general mental disorders and anxiety disorders.
• The SSI showed the best performance in identifying anxiety disorders, outperforming the GHQ.
• Excluding participants from previous studies improved the sensitivity of all screening tests, notably the GHQ.

Conclusions:

• The MHI is a valuable tool for screening primary care patients for mental health conditions.
• The SSI offers additional predictive value specifically for anxiety disorders.
• These findings support the integration of validated screening tools into routine primary care to improve mental health detection.