Utility of a New Procedure for Diagnosing Mental Disorders in Primary Care: The PRIME-MD 1000 Study

Robert L. Spitzer, Janet B.W. Williams, Jeffrey G. Johnson, Kurt Kroenke, Mark Linzer, Frank Verloin Degruy, David Brody, Steven R. Hahn

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2220 Scopus citations

Abstract

To assess the validity and utility of PRIME-MD (Primary Care Evaluation of Mental Disorders), a new rapid procedure for diagnosing mental disorders by primary care physicians. —Survey; criterion standard. —Four primary care clinics. —A total of 1000 adult patients (369 selected by convenience and 631 selected by site-specific methods to avoid sampling bias) assessed by 31 primary care physicians. —PRIME-MD diagnoses, independent diagnoses made by mental health professionals, functional status measures (Short-Form General Health Survey), disability days, health care utilization, and treatment/ referral decisions. —Twenty-six percent of the patients had a PRIME-MD diagnosis that met full criteria for a specific disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. The average time required of the primary care physician to complete the PRIME-MD evaluation was 8.4 minutes. There was good agreement between PRIME-MD diagnoses and those of independent mental health professionals (for the diagnosis of any PRIME-MD disorder, κ=0.71; overall accuracy rate=88%). Patients with PRIME-MD diagnoses had lower functioning, more disability days, and higher rates of health care utilization than did patients without PRIME-MD diagnoses (for all measures, P<.005). Nearly half (48%) of 287 patients with a PRIME-MD diagnosis who were somewhat or fairly well-known to their physicians had not been recognized to have that diagnosis before the PRIME-MD evaluation. A new treatment or referral was initiated for 62% of the 125 patients with a PRIME-MD diagnosis who were not already being treated. —PRIME-MD appears to be a useful tool for identifying mental disorders in primary care practice and research. (JAMA. 1994;272:1749-1756).

Original languageEnglish (US)
Pages (from-to)1749-1756
Number of pages8
JournalJAMA: The Journal of the American Medical Association
Volume272
Issue number22
DOIs
StatePublished - Dec 1994

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    Spitzer, R. L., Williams, J. B. W., Johnson, J. G., Kroenke, K., Linzer, M., Degruy, F. V., Brody, D., & Hahn, S. R. (1994). Utility of a New Procedure for Diagnosing Mental Disorders in Primary Care: The PRIME-MD 1000 Study. JAMA: The Journal of the American Medical Association, 272(22), 1749-1756. https://doi.org/10.1001/jama.1994.03520220043029