Case-finding for mental distress in primary health care: An evaluation of the performance of a five-item screening instrument

Peter J. Chipimo,Knut Fylkesnes

doi:10.4236/health.2013.53a083

Abstract

Background: There is an increased interest in developing better and more accurate methods to recognize and manage mental health problems in primary care settings. Abbreviated screening instruments for mental distress are useful tools for research and clinical practice. The present study seeks to investigate whether only a few questionnaire items from the Self-Reporting- Questionnaire-10 (SRQ-10) can be a robust method in the screening for Mental Distress in Primary Health care. Methods: We compared the screening accuracy of a short, five-item (SRQ-5) version of the SRQ-10 with that of the SRQ-20, General Health Questionnaire 12 (GHQ-12) using the DSM-IV axis as a gold standard and analyzed its performance in different diagnostic entities. We also assessed the correlation, sensitivity and specificity between the 4 instruments. All the instruments were administered to 400 primary health care attendees. Results: The estimated prevalence of mental distress was 13.6% in the study sample (Depression 11%, anxiety disorders 1.8%). The SRQ-5 was highly correlated to SRQ-10 (0.923, p Conclusion: This validation showed that in moving from SRQ with 10 or 20 items to one with merely 5 items, we do not seem to lose the screening prowess of the instrument. The SRQ-5 represents a simplified and less time-consuming screening instrument with strong performance characteristics. We therefore recommend it for inclusion into existing patient assessment protocols, thus enhancing case finding at primary health care level.

Highlights

There is an increased interest in developing better and more accurate methods to recognize and manage mental health problems in primary care settings
We have previously reported on the comparative validity of three screening instruments in detecting mental distress in a primary care setting using receiver-operatingcharacteristics as the quantitative measure of performance [13]
We extend our investigation of the SRQ by comparing the performance of its shortest version, the five item SRQ-5 with that of the SRQ-10, SRQ-20 and the GHQ using the DSM-IV as the gold standard

Summary

Introduction

There is an increased interest in developing better and more accurate methods to recognize and manage mental health problems in primary care settings. Some users of mental health services advocate for use of the term mental distress in describing their experience as they feel it better captures the sense of the uniqueness and personal nature of their experience, since everyone experiences distress at different times. A person with mental distress may exhibit symptoms described as psychiatric, such as: depression and anxiety, without being ‘ill’ in a medical sense [1]. These symptoms may resolve without further medical intervention, people who endure such symptoms in long run are more likely to be diagnosed with mental illness. Predictors known to induce mental distress include life situations such as: poor social and economic situation, bereavement, OPEN ACCESS

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