Faculty Collaboration Database

Clinical predictors of mental disorders among medical outpatients. Arch Intern Med 2001 Mar 26;161(6):875-9

Date

03/27/2001

Pubmed ID

11268232

DOI

10.1001/archinte.161.6.875

Scopus ID

2-s2.0-0035953116 (requires institutional sign-in at Scopus site)   49 Citations

Abstract

BACKGROUND: Mental disorders are common among primary care patients and often not detected by primary care physicians. We report on clinical cues that may allow physicians to target patients for psychiatric screening.

METHODS: Two hundred fifty consecutive adults presenting to a walk-in clinic completed previsit surveys assessing demographics, symptom characteristics, recent stress, functional status (Medical Outcomes Study Short Form-6), and mental disorders (Primary Care Evaluation of Mental Disorders [PRIME-MD]). Patients with positive findings for a mental disorder on the PRIME-MD underwent a semistructured interview. Immediately after the visit, physicians completed the Difficult Doctor Patient Relationship Questionnaire.

RESULTS: Patients averaged 50.5 years of age (range, 18-92 years). Little more than half were women (53%); 43%, white; 44%, African American; 8%, Hispanic; and 6%, other. Twenty-six percent had an underlying mental disorder; 11% had more than 1 mental disorder. Sixteen percent had a depressive disorder; 6%, major depression; 11%, an anxiety disorder; 2%, panic disorder; and 9%, a somatoform disorder. Independent correlates of a mental disorder included reporting recent stress (odds ratio [OR], 6.7; 95% confidence interval [CI], 3.3-13.6), having 5 or more physical symptoms (OR, 4.0; 95% CI, 2.1-7.9), or reporting health to be less than very good (OR, 2.2; 95% CI, 1.1-4.3). There was a stepwise increase in the likelihood of having a mental disorder and number of correlates present. Among patients with no predictors, only 2% had an underlying mental disorder, compared with 72% among patients with all 3 clinical predictors.

CONCLUSIONS: Patients who report recent stress, 5 or more physical symptoms, or poor health are more likely to have an underlying mental disorder. These clinical cues may allow clinicians to select patients in whom formal screening for mental disorders would be particularly fruitful.

Author List

Jackson JL, Houston JS, Hanling SR, Terhaar KA, Yun JS

Author

Jeffrey L. Jackson MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Family Practice
Female
Humans
Male
Mass Screening
Mental Disorders
Middle Aged
Outpatients
Predictive Value of Tests
Prevalence
Regression Analysis
Risk Factors
Stress, Psychological
Surveys and Questionnaires