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

  • V. Patel (a1) (a2), R. Araya (a3), N. Chowdhary (a2), M. King (a4), B. Kirkwood (a1), S. Nayak (a3), G. Simon (a5) and H. A. Weiss (a1)...
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.

Copyright
Corresponding author
*Address for correspondence: Professor V. Patel, Sangath Centre, 841/1 Alto Porvorim, Goa 403521, India. (Email: Vikram.patel@lshtm.ac.uk)
References
Hide All
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.
Andrews G, Slade T (2001). Interpreting scores on the Kessler Psychological Distress Scale (K10). Australian and New Zealand Journal of Public Health 25, 494497.
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.
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.
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.
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.
Gautam S, Nijhawan M, Kamal P (1987). Standardisation of the Hindi version of Goldberg's General Health Questionnaire. Indian Journal of Psychiatry 29, 6366.
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.
Goldberg D, Huxley P (1992). Common Mental Disorders: A Biosocial Model. Tavistock/Routledge: London.
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.
Goldberg D, Williams P (1988). A User's Guide to the General Health Questionnaire. NFER-Nelson: Windsor.
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.
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.
Hussain N, Creed F, Tomenson B (2000). Depression and social stress in Pakistan. Psychological Medicine 30, 395402.
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.
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.
Lewis G (1992). Dimensions of neurosis. Psychological Medicine 22, 10111018.
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.
Malhotra K, Schwartz T, Hameed U (2004). Presence of suicidality as a prognostic indicator. Journal of Postgraduate Medicine 50, 185188.
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.
NICE (2004). Depression: Management of Depression in Primary and Secondary Care. National Institute of Clinical Excellence: London.
Patel V (1999). The epidemiology of common mental disorders in South Asia. NIMHANS Journal 17, 307327.
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.
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.
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.
Patel V, Pereira J, Mann A (1998 b). Somatic and psychological models of common mental disorders in India. Psychological Medicine 28, 135143.
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.
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.
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.
Sen B (1987). Psychiatric phenomena in primary health care: their extent and nature. Indian Journal of Psychiatry 29, 3340.
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.
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.
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.
Simon GE (1998). Can depression be managed appropriately in primary care? Journal of Clinical Psychiatry 59 (Suppl. 2), 38.
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.
Srinivasan TN, Suresh TR (1990). Nonpsychotic morbidity in a general hospital: early detection based on presenting complaint. General Hospital Psychiatry 12, 4549.
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.
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.
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.
Zweig MH, Campbell G (1993). Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clinical Chemistry 39, 561577.
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Psychological Medicine
  • ISSN: 0033-2917
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