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Article
December 14, 1994

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

Author Affiliations

From the Biometrics Research Department, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY (Drs Spitzer, Williams, and Johnson); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (Dr Kroenke); Department of Medicine, New England Medical Center, Boston, Mass (Dr Linzer); Department of Family Practice in Community Medicine, University of South Alabama College of Medicine, Mobile (Dr deGruy); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (Dr Hahn); and Department of Medicine, Mercy Catholic Medical Center, Darby, Pa (Dr Brody).

JAMA. 1994;272(22):1749-1756. doi:10.1001/jama.1994.03520220043029
Abstract

Objective.  —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.

Design.  —Survey; criterion standard.

Setting.  —Four primary care clinics.

Subjects.  —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.

Main Outcome Measures.  —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.

Results.  —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.

Conclusion.  —PRIME-MD appears to be a useful tool for identifying mental disorders in primary care practice and research.(JAMA. 1994;272:1749-1756)

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