Janet B.W. Williams, D.S.W., Professor of Clinical Psychiatric Social Work, Department of Psychiatry, College of Physicians and Surgeons, Columbia University

Mental disorders are present as a primary or associated condition in at least 20% of primary care outpatients. However, studies have consistently shown that primary care physicians in office settings fail to diagnose and treat 50% to 75% of patients suffering from common mental disorders. Undoubtedly, a high percentage of clients seen in the social service sector also have undetected and untreated mental disorders. PRIME-MD is a procedure to facilitate rapid and accurate recognition and diagnosis of common mental disorders. The system was originally designed for use in primary care settings, but should be equally useful with social service clients.

PRIME-MD is designed both for the busy clinician and the researcher who needs a standardized but user-friendly diagnostic assessment procedure that can be completed quickly. PRIME-MD has two components: a one-page Patient Questionnaire (PQ) completed by the patient (or client) prior to seeing the clinician, and a Clinical Evaluation Guide (CEG) that the clinician uses to follow up on positive PQ responses. The PQ consists of 26 yes/no questions about symptoms and signs present during the past month, divided into five broad diagnostic areas: mood, anxiety, eating, alcohol, and somatoform disorders.

In a study of 1,000 primary care outpatients, the validity of the PRIME-MD system was supported by good agreement with diagnoses made by mental health professionals, multiple measures of patient functioning, health status, psychopathology, and health care utilization, and base rates for mental disorders comparable to studies using much lengthier structured diagnostic interview schedules. PRIME-MD enabled primary care physicians to identify previously unrecognized mental disorders and initiate therapy.

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