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Shabnam Nejati,1 Nashmil Ariai,1 Cecilia Björkelund,1 Ingmarie Skoglund,1,2 Eva-Lisa Petersson,1,2 Pia Augustsson,2 Dominique Hange,1,2 Irene Svenningsson1,2 1Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; 2Narhalsan Research and Development Primary Health Care, Region Vastra Gotaland, Gothenburg, SwedenCorrespondence: Dominique HangePrimary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 454, Gothenburg SE-405 30, SwedenTel +46 722 245 700Email dominique.hange@vgregion.seObjective: To investigate the correspondence between the diagnoses received by patients with symptoms of common mental disorder attending primary care, based on the diagnostic instrument International Neuropsychiatric Interview (M.I.N.I.) and the self-assessment instruments such as Beck Depression Inventory (BDI-II) and Montgomery–Asberg Depression Rating Scale – self-rating version (MADRS-S), respectively.Design: Data were collected from a prospective observational study, ADAS, between 2014 and 2015.Setting: Twenty-eight primary care centers in Region Västra Gotaland, Sweden.Patients: A total of 192 patients, 18– 60 years of age, on sick leave ≥ 14 days, with mild/moderate depression, anxiety syndrome, and stress-related mental illness were included.Main Outcome Measures: Scores of the assessment instruments (BDI-II and MADRS-S) on inclusion, sensitivity, specificity, positive (PPV) and negative predictive value (NPV) for BDI-II and MADRS-S, respectively, with M.I.N.I used as diagnostic instrument.Results: Using M.I.N.I. as gold standard, the BDI-II and MADRS-S showed almost the same sensitivity (86.9% and 87.4%, respectively), but specificity for MADRS-S was doubled compared to BDI-II (36% and 18%, respectively). There was a significant association between MADRS-S and M.I.N.I. (p=0.027). However, the same analysis between BDI and M.I.N.I. was not statistically significant (p= 0.635). NPV and PPV were calculated from assumed prevalences (10% and 75%) and were higher for MADRS-S compared to BDI-II. The PPV differences were between 2% and 7% and NPV differences were between 3% and 19%.Conclusion: With M.I.N.I. as gold standard, MADRS-S performs better than BDI-II as a self-assessment tool in the primary care context for depression diagnostics.Keywords: depression, diagnostic instrument, primary care, self-assessment instrument |
