Utility of a New Procedure for Diagnosing Mental Disorders in Primary Care: The PRIME-MD 1000 Study.
Robert L. Spitzer, MD; Janet B. W. Williams, DSW; Kurt Kroenke, MD; Mark Linzer, MD; Frank Verloin deGruy, MD III; Steven R. Hahn, MD; David Brody, MD; Jeffrey G. Johnson, PhD
[Article] JAMA. 272(22):1749-1756, December 14, 1994.

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Objective: To assess the validity and utility of PRIME-MD (Primary Care Evaluation of Mental Disorders), a new rapid procedure for diagnosing mental disorders by primary care physicians.

Design: Survey; criterion standard.

Setting: Four primary care clinics.

Subjects: A total of 1000 adult patients (369 selected by convenience and 631 selected by site-specific methods to avoid sampling bias) assessed by 31 primary care physicians.

Main Outcome Measures: PRIME-MD diagnoses, independent diagnoses made by mental health professionals, functional status measures (Short-Form General Health Survey), disability days, health care utilization, and treatment/referral decisions.

Results: Twenty-six percent of the patients had a PRIME-MD diagnosis that met full criteria for a specific disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. The average time required of the primary care physician to complete the PRIME-MD evaluation was 8.4 minutes. There was good agreement between PRIME-MD diagnoses and those of independent mental health professionals (for the diagnosis of any PRIME-MD disorder, kappa=0.71; overall accuracy rate=88%). Patients with PRIME-MD diagnoses had lower functioning, more disability days, and higher rates of health care utilization than did patients without PRIME-MD diagnoses (for all measures, P<.005). Nearly half (48%) of 287 patients with a PRIME-MD diagnosis who were somewhat or fairly well-known to their physicians had not been recognized to have that diagnosis before the PRIME-MD evaluation. A new treatment or referral was initiated for 62% of the 125 patients with a PRIME-MD diagnosis who were not already being treated.

Conclusion: PRIME-MD appears to be a useful tool for identifying mental disorders in primary care practice and research.

(JAMA. 1994;272:1749-1756).

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