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Brief Diagnostic Interviews (SDDS-PC) for Multiple Mental Disorders in Primary CareA Pilot Study
Myrna M. Weissman, PhD;
Mark Olfson, MD;
Andrew C. Leon, PhD;
W. Eugene Broadhead, MD, PhD;
Thomas T. Gilbert, MD, MPH;
Edmund S. Higgins, MD;
James E. Barrett, MD;
Robert S. Blacklow, MD;
Martin B. Keller, MD;
Christina Hoven, DrPH
Arch Fam Med. 1995;4(3):220-227.
Abstract
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Objective
To pilot test the feasibility and validity of new, brief, structured, physician-administered diagnostic interviews for six mental disorders in primary care patients identified from a patient-completed screen.
Design
Comparison of the new diagnostic interviews with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, version P (SCID-P), administered independently by a mental health professional.
Setting
Three Rhode Island family practices and a South Carolina family medicine residency.
Subjects
Consecutive patients of either sex, aged 18 to 70 years, who were able to read and write English were eligible for screening; 775 patients completed the screen. Of these, 246 screened positive for at least one disorder and received at least one module. Of these, 158 received a SCID-P interview.
Results
The diagnostic interviews were found useful by all 16 participating physicians. Eighty-seven percent reported that they diagnosed a new mental problem, and 93% said that the modules clarified suspected symptoms. However, 26% thought the procedure was too time consuming, and 80% believed that reimbursement would be necessary for routine use. Detection of cases using the diagnostic modules was associated with physician intervention and with independent assessment of patient impairment. Over three quarters of the patients (76.4%) who were classified as positive by the physician interview for any of the diagnoses also tested positive on the SCID-P. Two thirds of the patients (62.7%) with at least one of the disorders (according to SCID-P) were classified by the physician interview as having a mental disorder. However, the operating characteristics varied across specific disorders and indicated a need for revisions and testing in larger samples.
Conclusions
These brief physician-administered diagnostic interview modules are part of a screening and diagnostic system (Symptom-Driven Diagnostic System for Primary Care [SDDS-PC], The Upjohn Co, Kalamazoo, Mich) to detect mental disorders in primary care patients. The pilot results help establish their feasibility and validity.
Author Affiliations
From the College of Physicians and Surgeons of Columbia University and the New York State Psychiatric Institute (Drs Weissman, Olfson, and Hoven), and Cornell University Medical College (Dr Leon), New York, NY; Duke University Medical Center, Durham, NC (Dr Broadhead); Brown University School of Medicine, Providence, Ri (Drs Gilbert and Keller); the Medical Univer sity of South Carolina, Charleston (Dr Higgins); Dartmouth Medical School, Hanover, NH (Dr Barrett) and Northeastern Ohio Universities College of Medicine, Rootstown (Dr Blacklow). Drs Weissman, Olfson, Leon, Broadhead, Higgins, Barrett, and Keller have served as consultants to the Upjohn Co, Kalamazoo, Mich.
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