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Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires

Published online by Cambridge University Press:  30 November 2007

V. Patel*
Affiliation:
London School of Hygiene and Tropical Medicine, London, UK Sangath, Alto-Porvorim, Goa, India
R. Araya
Affiliation:
University of Bristol, Bristol, UK
N. Chowdhary
Affiliation:
Sangath, Alto-Porvorim, Goa, India
M. King
Affiliation:
Royal Free and University College Medical School, London, UK
B. Kirkwood
Affiliation:
London School of Hygiene and Tropical Medicine, London, UK
S. Nayak
Affiliation:
University of Bristol, Bristol, UK
G. Simon
Affiliation:
Center for Health Studies, Group Health Cooperative, Seattle, USA
H. A. Weiss
Affiliation:
London School of Hygiene and Tropical Medicine, London, UK
*
*Address for correspondence: Professor V. Patel, Sangath Centre, 841/1 Alto Porvorim, Goa 403521, India. (Email: Vikram.patel@lshtm.ac.uk)

Abstract

Background

Screening of patients for common mental disorders (CMDs) is needed in primary-care management programmes. This study aimed to compare the screening properties of five widely used questionnaires.

Method

Adult attenders in five primary-care settings in India were recruited through systematic sampling. Four questionnaires were administered, in pairs, in random order to participants: the General Health Questionnaire (GHQ, 12 items); the Primary Health Questionnaire (PHQ, nine items); the Kessler Psychological Distress Scale (K10, 10 items), and from which we could extract the score of the shorter 6-item K6; and the Self-Reporting Questionnaire (SRQ, 20 items). All participants were interviewed with a structured lay diagnostic interview, the Revised Clinical Interview Schedule (CIS-R).

Results

Complete data were available for 598 participants (participation rate 99.3%). All five questionnaires showed moderate to high discriminating ability; the GHQ and SRQ showed the best results. All five showed moderate to high degrees of correlation with one another, the poorest being between the two shortest questionnaires, K6 and PHQ. All five had relatively good internal consistency. However, the positive predictive value (PPV) of the questionnaires compared with the diagnostic interview ranged from 51% to 77% at the optimal cut-off scores.

Conclusions

There is little difference in the ability of these questionnaires to identify cases accurately, but none showed high PPVs without a considerable compromise on sensitivity. Hence, the choice of an optimum cut-off score that yields the best balance between sensitivity and PPV may need to be tailored to individual settings, with a higher cut-off being recommended in resource-limited primary-care settings.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2007

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References

Adewuya, AD, Ola, BA, Afolabi, OO (2006). Validity of the Patient Health Questionnaire PHQ-9 as a screening tool for depression amongst Nigerian university students. Journal of Affective Disorders 96, 8993.CrossRefGoogle ScholarPubMed
Andrews, G, Slade, T (2001). Interpreting scores on the Kessler Psychological Distress Scale (K10). Australian and New Zealand Journal of Public Health 25, 494497.CrossRefGoogle ScholarPubMed
Bower, P, Gilbody, S, Richards, D, Fletcher, J, Sutton, A (2006). Collaborative care for depression in primary care. Making sense of a complex intervention: systematic review and meta-regression. British Journal of Psychiatry 189, 484493.CrossRefGoogle ScholarPubMed
Cairney, J, Veldhuizen, S, Wade, TJ, Kurdyak, P, Streiner, DL (2007). Evaluation of two measures of psychological distress as screeners for depression in the general population. Canadian Journal of Psychiatry 52, 111120.CrossRefGoogle Scholar
Chen, TM, Huang, FY, Chang, C, Chung, H (2006). Using the PHQ-9 for depression screening and treatment monitoring for Chinese Americans in primary care. Psychiatric Services 57, 976981.CrossRefGoogle ScholarPubMed
Furukawa, TA, Kessler, RC, Slade, T, Andrews, G (2003). The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being. Psychological Medicine 33, 357362.CrossRefGoogle ScholarPubMed
Gautam, S, Nijhawan, M, Kamal, P (1987). Standardisation of the Hindi version of Goldberg's General Health Questionnaire. Indian Journal of Psychiatry 29, 6366.Google Scholar
Gerrity, MS, Cole, SA, Dietrich, AJ, Barrett, JE (1999). Improving the recognition and management of depression: is there a role for physician education? Journal of Family Practice 48, 949957.Google Scholar
Goldberg, D, Huxley, P (1992). Common Mental Disorders: A Biosocial Model. Tavistock/Routledge: London.Google Scholar
Goldberg, D, Lecrubier, Y (1995). Form and frequency of mental disorders across cultures. In Mental Illness in General Health Care: An International Study (ed. Ustun, T. B. and Sartorius, N.), pp. 323334. John Wiley & Sons: Chichester.Google Scholar
Goldberg, D, Williams, P (1988). A User's Guide to the General Health Questionnaire. NFER-Nelson: Windsor.Google Scholar
Harding, TW, De Arango, MV, Baltazar, J, Climent, CE, Ibrahim, HHA, Ladrigo-Ignacio, L, Srinivasa Murthy, R, Wig, NN (1980). Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries. Psychological Medicine 10, 231241.CrossRefGoogle ScholarPubMed
Hodges, B, Inch, C, Silver, I (2001). Improving the psychiatric knowledge, skills, and attitudes of primary care physicians, 1995–2000: a review. American Journal of Psychiatry 158, 15791586.CrossRefGoogle Scholar
Hussain, N, Creed, F, Tomenson, B (2000). Depression and social stress in Pakistan. Psychological Medicine 30, 395402.CrossRefGoogle Scholar
Jacob, KS, Everitt, B, Patel, V, Weich, S, Araya, R, Lewis, G (1998). The comparison of latent trait variable models of non-psychotic psychiatric morbidity in four culturally diverse populations. Psychological Medicine 28, 145152.CrossRefGoogle Scholar
Kessler, RC, Andrews, G, Colpe, LJ, Hripi, E, Mroczek, DK, Normand, SLT, Walters, EE, Zaslavsky, AM (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine 32, 959976.CrossRefGoogle ScholarPubMed
Lewis, G (1992). Dimensions of neurosis. Psychological Medicine 22, 10111018.CrossRefGoogle ScholarPubMed
Lewis, G, Pelosi, A, Araya, R, Dunn, G (1992). Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychological Medicine 22, 465486.CrossRefGoogle ScholarPubMed
Malhotra, K, Schwartz, T, Hameed, U (2004). Presence of suicidality as a prognostic indicator. Journal of Postgraduate Medicine 50, 185188.Google ScholarPubMed
Mulrow, CD, Williams, JW Jr., Gerety, MB, Ramirez, G, Montiel, OM, Kerber, C (1995). Case-finding instruments for depression in primary care settings. Annals of Internal Medicine 122, 913921.CrossRefGoogle ScholarPubMed
NICE (2004). Depression: Management of Depression in Primary and Secondary Care. National Institute of Clinical Excellence: London.Google Scholar
Patel, V (1999). The epidemiology of common mental disorders in South Asia. NIMHANS Journal 17, 307327.Google Scholar
Patel, V, Chisholm, D, Rabe-Hesketh, S, Dias-Saxena, F, Andrew, G, Mann, A (2003). The efficacy and cost-effectiveness of a drug and psychological treatment for common mental disorders in general health care in Goa, India: a randomised controlled trial. Lancet 361, 3339.CrossRefGoogle ScholarPubMed
Patel, V, Kirkwood, BR, Pednekar, S, Pereira, B, Barros, P, Fernandes, J, Datta, J, Pai, R, Weiss, H, Mabey, D (2006). Gender disadvantage and reproductive health risk factors for common mental disorders in women: a community survey in India. Archives of General Psychiatry 63, 404413.CrossRefGoogle ScholarPubMed
Patel, V, Pereira, J, Coutinho, L, Fernandes, R, Fernandes, J, Mann, A (1998 a). Poverty, psychological disorder and disability in primary care attenders in Goa, India. British Journal of Psychiatry 171, 533536.CrossRefGoogle Scholar
Patel, V, Pereira, J, Mann, A (1998 b). Somatic and psychological models of common mental disorders in India. Psychological Medicine 28, 135143.CrossRefGoogle ScholarPubMed
Patel, V, Rodrigues, M, De Souza, N (2002). Gender, poverty and post-natal depression: a cohort study from Goa, India. American Journal of Psychiatry 159, 4347.CrossRefGoogle ScholarPubMed
Pothen, M, Kuruvilla, A, Philip, K, Joseph, A, Jacob, KS (2003). Common mental disorders among primary care attenders in Vellore, South India: nature, prevalence and risk factors. International Journal of Social Psychiatry 49, 119125.CrossRefGoogle ScholarPubMed
Sartorius, N, Kuyken, W (1994). Translation of health status instruments. In Quality of Life Assessment: International Perspectives (ed. Orley, J. and Kuyken, W.), pp. 318. Springer-Verlag: Berlin.CrossRefGoogle Scholar
Sen, B (1987). Psychiatric phenomena in primary health care: their extent and nature. Indian Journal of Psychiatry 29, 3340.CrossRefGoogle ScholarPubMed
Sen, B, Williams, P (1987). The extent and nature of depressive phenomena in primary health care: a study in Calcutta, India. British Journal of Psychiatry 151, 486493.CrossRefGoogle ScholarPubMed
Shamasundar, C, Krishna Murthy, S, Prakash, O, Prabhakar, N, Subbakrishna, D (1986 a). Psychiatric morbidity in a general practice in an Indian city. British Medical Journal 292, 17131715.CrossRefGoogle Scholar
Shamasundar, C, Sriram, T, Murali Raj, G, Shanmugham, V (1986 b). Validity of a short 5-item version of the General Health Questionnaire (G.H.Q.). Indian Journal of Psychiatry 28, 217219.Google Scholar
Simon, GE (1998). Can depression be managed appropriately in primary care? Journal of Clinical Psychiatry 59 (Suppl. 2), 38.Google ScholarPubMed
Spitzer, RL, Kroenke, K, Williams, JB (1999). Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. Journal of the American Medical Association 282, 17371744.CrossRefGoogle ScholarPubMed
Srinivasan, TN, Suresh, TR (1990). Nonpsychotic morbidity in a general hospital: early detection based on presenting complaint. General Hospital Psychiatry 12, 4549.CrossRefGoogle Scholar
Thompson, C, Kinmonth, AL, Stevens, L (2000). Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial. Lancet 355, 185191.CrossRefGoogle ScholarPubMed
Wittchen, H, Robins, LN, Cottler, LB, Sartorius, N, Burke, JD, Regier, D (1991). Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The Multicentre WHO/ADAMHA Field Trial. British Journal of Psychiatry 159, 645653, 658.CrossRefGoogle Scholar
Wulsin, L, Somoza, E, Heck, J (2002). The feasibility of using the Spanish PHQ-9 to screen for depression in primary care in Honduras. Primary Care Companion to the Journal of Clinical Psychiatry 4, 191195.Google ScholarPubMed
Zweig, MH, Campbell, G (1993). Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clinical Chemistry 39, 561577.CrossRefGoogle ScholarPubMed