The psychosocial evaluation of medically-ill inpatients - accordance between mental disorders and self-rated psychosocial distress

BACKGROUND Both psychometric questionnaires and structured psychodiagnostic interviews are used to identify medically-ill inpatients requiring psychotherapeutic treatment. The study examines the accordance between the diagnosis of a mental disorder (ICD-10) and self-rated psychosocial distress of unselected inpatients within the framework of a psychosomatic liaison service. METHODS Of n=532 consecutive patients hospitalized in five departments of the University Hospital Freiburg, n=357 patients underwent a structured psychodiagnostic interview (Mini-DIPS) to obtain diagnoses according to ICD-10 F. Psychosocial distress (HADS), somatoform symptoms (SOMS-2 J), quality of life (EDLQ) and coping strategies (FQCI) were evaluated by self-rating questionnaires. RESULTS A mental disorder requiring treatment was diagnosed in 44% of the patients. Predictors for the diagnosis of a mental disorder were the depression subscale of the HADS, the frequency of somatoform symptoms and depressive coping. The greatest accordance between mental disorders and screening instruments was found for the depression subscale of the HADS at a cut-off 8+. The area under the curve (AUC) was 0.75. With a specificity of 87% and a sensitivity of 53%, nearly half of all mental disorders requiring treatment were not identified by the HADS, especially in patients with neurotic, stress-related and somatoform disorders (F4), most of them cancer patients with adjustment disorders. CONCLUSIONS Case selection by the HADS is successfull in disorders, where depressive symptoms are prevalent. For F4-diagnoses a lower cut-off of 6+ is recommended. The importance of a clinical interview is underlined. Other screening procedures, specific for the general hospital population, are discussed.