BioPsychoSocial Assessment Tools for the Elderly - Assessment Summary Sheet

Test: Primary Care Evaluation of Mental Heath Disorders (PRIME-MD®)

Year: 1994

Domain: Psychological/Social

Assessment Tool Category: Mental Health

Variations/Translations: The Primary Health Assessment tool (PHA-9 and PHA-2) has been developed as abbreviated versions of the original PRIME-MD.

Setting: Primary Care Population

Method of Delivery: This instrument works favourably with trained mental health providers and includes both a questionnaire and interview.

Description: This tool is designed to diagnose mental health problems in the primary care sector. It is used in the senior population due to high incidences of undiagnosed and untreated depression. The instrument consists of two basic components: a one-page questionnaire (PQ) completed by the patient before seeing the health providers and a 12-page clinician evaluation guide (CEG). The PQ consists of 26 questions regarding physical symptoms and mental health problems. The self-administered questionnaire targets five basic areas: mood, anxiety, somatoform, eating disorders and alcohol abuse. The CEG is a structured interview form that the clinician uses to follow up on positive responses on the PQ. The instrument can be used flexibly; it can be incorporated into routine protocol or as a diagnostic tool with people in whom mental health problems are suspected or who pose management problems.

Scoring/Interpretation: Using the five basic categories from the PQ, the clinician can determine the presence or absence of specific Diagnostic and Statistical Mental Disorder (DSM-IV) categories: major depression, partial remission or reoccurrence of major depressive disorder, dysthymia, panic disorder, generalized anxiety disorder, bulimia nervosa, multisomatoform disorder, somatoform pain disorder, and hypochondriasis. Another six disorders are viewed as "subthreshold" because they meet fewer criteria than are required for DSM-IV diagnosis: anxiety disorders “Not Other Specified” (NOS), somatoform disorder NOS, eating disorder NOS, minor depressive disorder, and binge eating disorder; alcohol dependence is also included in this group. More information regarding scoring can be found in the published manual.

Time to Administer: The self-reported questionnaire takes approximately 5-10 minutes. The clinician evaluation guide lasts approximately 7-10 minutes with an average of 8.4 minutes.

Availability: The PRIME-MD PQ and CEG are accompanied by a 13-page manual, which includes information regarding reimbursement for the evaluation (which is under copyright of Pfizer, Inc).  Complimentary copies of the PRIME-MD can be obtained from: Robert L. Spitzer at rls8@columbia.edu

Software: N/A

Website: Questions can be directed to the PRIME-MD® designer Dr. Robert Pfizer by email at , by mail (see above) or by viewing the web site http://www.pfizer.com

Quantitative/Qualitative: Mixed Methods (quantitative questionnaire and qualitative follow-up evaluation, if necessary)

Validity (Quantitative): The concurrent validity of PRIME-MD was supported by strong relationships that were obtained between PRIME-MD diagnoses of mood, anxiety, and somatoform disorders and corresponding patient self-rated severity scales. More information can be found in the original article by Spitzer et al. (1994).

Reliability (Quantitative): Modest inter-rater reliability was found in the original article by Spitzer et al. (1994). Kappa coefficients for inter-rater reliability of major depressive disorder using the PRIME-MD CEG structured interview are satisfactory (k=.61).  In general, the PRIME-MD has been shown to display good sensitivity (.81), specificity (.98) and diagnostic accuracy (.98). Recent research by Bakker et al. (2009) reports that statistically significant test-retest reliability for PRIME-MD has been established. Agreement was highest for more severe threshold disorders but was not sufficient for subthreshold disorders.

References:

Bakker, I.M., Terluin, B., van Marwijk, H.W.J., van Mechelen,W., & Stalman, W.A.B. (2009). Test-retest reliability of the PRIME-MD: Limitations in diagnosing mental disorders in primary care. European Journal of Public Health, 19(3), 303-307.

Kroenke, K., Spitzer, R.L., & Williams, J.B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613.

Spitzer, R.L., Kroenke, K., & Williams, J.B. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. JAMA, 282, 1737-1744.

Spitzer, R.L., Williams, J.B.W., Kroenke, K., Linzer, M., deGruy III, F.V., Hahn, S.R., …Hohnson, J.J.G. (1994). Utility of a new procedure for diagnosing mental disorders in primary care: The PRIME-MD 1000 Study. JAMA, 272, 1749-1756.

Van Hook, M.P., Berkman, B., & Dunkle, R. (1996). Assessment tools for general health care settings: PRIME-MD, OARS, and SF-36. Health and Social Work, 21(3), 230-234.

Comments: N/A