A provisional screening instrument for four common mental disorders in adult primary care patients

Psychosomatics. Jan-Feb 2011;52(1):48-55. doi: 10.1016/j.psym.2010.11.011.


Objective: To develop an adult self-report instrument for provisional diagnosis of four common mental disorders in primary care patients.

Methods: Primary care patients were evaluated during routine clinic visits with a self-report screening tool comprised of 85 DSM-IV symptom-based candidate questions. Patients with a physician-assessed provisional diagnosis for generalized anxiety disorder (GAD), major depressive episode (MDE), past/present mania, and adult attention-deficit/hyperactivity disorder (ADHD), or none of these, completed additional self-report clinical questionnaires, and then were interviewed on the telephone by a trained rater for a SCID/ACDS diagnosis. Responses to the symptom-based candidate questions were used to calculate sensitivity and specificity for a SCID/ACDS diagnosis (GAD, N = 24; MDE, N = 89; Mania, N = 24; ADHD, N = 65) and to select the optimal four questions for each diagnosis to be included in the instrument.

Results: Analyses resulted in a 17-item instrument for provisional differential diagnosis of GAD, MDE, past/present mania, and ADHD. Comparison of limited symptom-based versus full DSM-IV criteria-based diagnosis showed minimal differences for relative diagnostic accuracy. Sensitivities and specificities, respectively, were 83% and 75% for GAD, 80% and 80% for MDE, 83% and 82% for mania, and 82%and 73% for ADHD.

Conclusions: Based on this preliminary work, the Provisional Diagnostic Instrument-4 is a brief, easily scored, self-report instrument that may assist primary care physicians to identify potential cases of GAD, MDE, past/present mania, and ADHD.

Publication types

  • Evaluation Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / psychology
  • Attention Deficit Disorder with Hyperactivity / diagnosis
  • Attention Deficit Disorder with Hyperactivity / psychology
  • Bipolar Disorder / diagnosis
  • Bipolar Disorder / psychology
  • Cross-Sectional Studies
  • Depressive Disorder, Major / diagnosis
  • Depressive Disorder, Major / psychology
  • Female
  • Humans
  • Interviews as Topic
  • Male
  • Mass Screening / instrumentation*
  • Mass Screening / methods
  • Mental Disorders / diagnosis*
  • Mental Disorders / psychology
  • Middle Aged
  • Primary Health Care / methods*
  • Reproducibility of Results
  • Self Report*
  • Sensitivity and Specificity
  • Surveys and Questionnaires*
  • United States