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A cluster-randomised trial evaluating an intervention for patients with stress-related mental disorders and sick leave in primary care
Bakker, Ingrid M; Terluin, Berend; van Marwijk, Harm WJ J; van der Windt, Daniëlle A W M; Rijmen, Frank; van Mechelen, Willem; Stalman, Wim AB B; Van, Mechelen W; Stalman, Wim AB B; van Mechelen, Willem; Stalman, Wim AB B; Terluin, Berend; Anema, Johannes R; van Mechelen, Willem; Stalman, Wim AB B; van Marwijk, Harm WJ J; Van, Mechelen W; Stalman, Wim AB B; Gundy, C M; Smit, J H; Van, Mechelen W; Stalman, Wim AB B
PLoS clinical trials. 2007;78(1464-360X (Electronic)):124.
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Abstract
BACKGROUND: The primary care evaluation of mental disorders (PRIME-MD) can be seen as characteristic for successive refinements of criteria and structured interview techniques for diagnosing psychiatric disorders in primary care. It is one of the most widely used instruments, but there is no evidence to support its test-retest reliability. METHODS: With 1-week intervals between interviews, a test-retest study of the PRIME-MD was conducted in a general practice population of 100 distressed patients (20- to 60-years old) who were on sick leave. RESULTS: Almost everyone (89{\%}) received one or more diagnoses at both measurements, and there was fair total agreement (kappa = 0.27). The best agreement was found for more severe threshold disorders [major depressive disorder (kappa = 0.58), dysthymia (kappa = 0.57), and generalized anxiety disorder (kappa = 0.59)], while we found indefinite results for the sub-threshold disorders [anxiety disorder not otherwise specified (NOS) (kappa =.30), minor depressive disorder (kappa = -0.03), and somatoform disorder NOS (kappa = 0.11)]. CONCLUSION: The PRIME-MD is one of the few instruments in primary care that actually diagnoses specific mental disorders according to the DSM criteria. However, there was a failure to adequately classify sub-threshold disorders. Mental disorders, as seen in primary care, encompass important specific symptoms and clinical syndromes that vary in duration and severity over time, but they also encompass an admixture of somatic and psychological symptoms that do not match current diagnostic systems. This most likely resulted in methodological uncertainty about the level of agreement. Diagnostic criteria in psychiatry need to be operationalized for use in primary care and require further evaluation
Keyword(s)
AGREEMENT; Adult; Anxiety; Anxiety Disorders; Attention; Clinical Protocols; Cluster Analysis; Counseling; Depression; Depressive Disorder; Diagnostic and Statistical Manual of Mental Disord; Educational Status; Family Practice; Female; GENERAL-PRACTICE; Humans; Intervention Studies; Interviews; Male; Marital Status; Mass Screening; Mental Disorders; Mental Health; Mental Status Schedule; Middle Aged; Netherlands; Outcome Assessment (Health Care); PRIMARY-CARE; Patient Education as Topic; Patients; Physicians; Prevalence; Primary Health Care; Psychiatry; Psychological; RELIABILITY; Randomized Controlled Trials as Topic; Referral and Consultation; Reproducibility of Results; Research; Sick Leave; Software Design; Stress; Uncertainty; Young Adult; complications; diagnosis; education; etiology; methods; therapy
Bibliographic metadata
- Bakker, Ingrid M
- Terluin, Berend
- van Marwijk, Harm WJ J
- van der Windt, Daniëlle A W M
- Rijmen, Frank
- van Mechelen, Willem
- Stalman, Wim AB B
- Van, Mechelen W
- Stalman, Wim AB B
- van Mechelen, Willem
- Stalman, Wim AB B
- Terluin, Berend
- Anema, Johannes R
- van Mechelen, Willem
- Stalman, Wim AB B
- van Marwijk, Harm WJ J
- Van, Mechelen W
- Stalman, Wim AB B
- Gundy, C M
- Smit, J H
- Van, Mechelen W
- Stalman, Wim AB B
- Related website http://linkinghub.elsevier.com/retrieve/pii/S0738399109002687 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1885369{\&}tool=pmcentrez{\&}rendertype=abstract