Abstract
BACKGROUND: Research on questionnaires as screening tools for psychiatric disorders has yielded conflicting results. AIM: To examine the effect of a routinely administered questionnaire on recognition of common psychiatric disorders in general practice. DESIGN OF STUDY: Randomised controlled trial. SETTING: Twenty-eight general practices in Aarhus County, Denmark. METHOD: Thirty-eight general practitioners (GPs) and 1785 consecutive patients, aged 18-65 years old, presenting with a new health problem, participated. Before consultation, patients were screened using a brief screening questionnaire (SQ) including somatisation, anxiety, depression, and alcohol abuse scales. Patients were randomised to one of two groups: 900 questionnaires were disclosed and scored by the GPs, 885 were blinded. A stratified subsample of 701 patients was interviewed after the consultation using a standardised psychiatric research interview (SCAN). RESULTS: Overall the GPs' recognition rates were 14% (95% confidence interval [CI] = -2 to 30) better for depression and 35% (95% CI = 2 to 68) better for alcohol problems when SQs were disclosed. Recognition rates for anxiety improved 8% (95% CI = -9 to 26) overall. In the case of somatoform disorders, disclosure showed no effect overall. Among those with high SQ scores, however, disclosure increased recognition rates on any mental disorder evaluated. CONCLUSION: This study demonstrated limited usefulness for routine screening for common psychiatric disorders. However, findings suggest that the SQ may be useful for case-finding among a subgroup of patients with high SQ scores.
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Selected References
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- Dunn G., Pickles A., Tansella M., Vázquez-Barquero J. L. Two-phase epidemiological surveys in psychiatric research. Br J Psychiatry. 1999 Feb;174:95–100. doi: 10.1192/bjp.174.2.95. [DOI] [PubMed] [Google Scholar]
- Ewing J. A. Detecting alcoholism. The CAGE questionnaire. JAMA. 1984 Oct 12;252(14):1905–1907. doi: 10.1001/jama.252.14.1905. [DOI] [PubMed] [Google Scholar]
- Fink P., Ewald H., Jensen J., Sørensen L., Engberg M., Holm M., Munk-Jørgensen P. Screening for somatization and hypochondriasis in primary care and neurological in-patients: a seven-item scale for hypochondriasis and somatization. J Psychosom Res. 1999 Mar;46(3):261–273. doi: 10.1016/s0022-3999(98)00092-0. [DOI] [PubMed] [Google Scholar]
- Fink P., Jensen J., Borgquist L., Brevik J. I., Dalgard O. S., Sandager I., Engberg M., Hansson L., Holm M., Joukamaa M. Psychiatric morbidity in primary public health care: a Nordic multicentre investigation. Part I: method and prevalence of psychiatric morbidity. Acta Psychiatr Scand. 1995 Dec;92(6):409–418. doi: 10.1111/j.1600-0447.1995.tb09605.x. [DOI] [PubMed] [Google Scholar]
- Fink P., Sørensen L., Engberg M., Holm M., Munk-Jørgensen P. Somatization in primary care. Prevalence, health care utilization, and general practitioner recognition. Psychosomatics. 1999 Jul-Aug;40(4):330–338. doi: 10.1016/S0033-3182(99)71228-4. [DOI] [PubMed] [Google Scholar]
- Fink Per, Rosendal Marianne, Toft Tomas. Assessment and treatment of functional disorders in general practice: the extended reattribution and management model--an advanced educational program for nonpsychiatric doctors. Psychosomatics. 2002 Mar-Apr;43(2):93–131. doi: 10.1176/appi.psy.43.2.93. [DOI] [PubMed] [Google Scholar]
- Gilbody S. M., House A. O., Sheldon T. A. Routinely administered questionnaires for depression and anxiety: systematic review. BMJ. 2001 Feb 17;322(7283):406–409. doi: 10.1136/bmj.322.7283.406. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kirmayer L. J., Robbins J. M. Three forms of somatization in primary care: prevalence, co-occurrence, and sociodemographic characteristics. J Nerv Ment Dis. 1991 Nov;179(11):647–655. doi: 10.1097/00005053-199111000-00001. [DOI] [PubMed] [Google Scholar]
- Kroenke K., Spitzer R. L., deGruy F. V., 3rd, Hahn S. R., Linzer M., Williams J. B., Brody D., Davies M. Multisomatoform disorder. An alternative to undifferentiated somatoform disorder for the somatizing patient in primary care. Arch Gen Psychiatry. 1997 Apr;54(4):352–358. doi: 10.1001/archpsyc.1997.01830160080011. [DOI] [PubMed] [Google Scholar]
- Peveler R., Kilkenny L., Kinmonth A. L. Medically unexplained physical symptoms in primary care: a comparison of self-report screening questionnaires and clinical opinion. J Psychosom Res. 1997 Mar;42(3):245–252. doi: 10.1016/s0022-3999(96)00292-9. [DOI] [PubMed] [Google Scholar]
- Schilte A. F., Portegijs P. J., Blankenstein A. H., Knottnerus J. A. Somatisation in primary care: clinical judgement and standardised measurement compared. Soc Psychiatry Psychiatr Epidemiol. 2000 Jun;35(6):276–282. doi: 10.1007/s001270050239. [DOI] [PubMed] [Google Scholar]
- Spitzer R. L., Kroenke K., Williams J. B. 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. JAMA. 1999 Nov 10;282(18):1737–1744. doi: 10.1001/jama.282.18.1737. [DOI] [PubMed] [Google Scholar]
- Spitzer R. L., Williams J. B., Kroenke K., Linzer M., deGruy F. V., 3rd, Hahn S. R., Brody D., Johnson J. G. Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA. 1994 Dec 14;272(22):1749–1756. [PubMed] [Google Scholar]
- Staab J. P., Datto C. J., Weinrieb R. M., Gariti P., Rynn M., Evans D. L. Detection and diagnosis of psychiatric disorders in primary medical care settings. Med Clin North Am. 2001 May;85(3):579–596. doi: 10.1016/s0025-7125(05)70330-8. [DOI] [PubMed] [Google Scholar]