The PHQ Primary Care Study

MENTAL DISORDERS IN PRImary care are common, disabling, costly, and treatable. However, they are frequently unrecognized and therefore not treated. Although there have been many screening instruments developed, PRIME-MD (Primary Care Evaluation of Mental Disorders) was the first instrument designed for use in primary care that actually diagnoses specific disorders using diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). PRIME-MD is a 2-stage system in which the patient first completes a 26-item self-administered questionnaire that screens for 5 of the most common groups of disorders in primary care: depressive, anxiety, alcohol, somatoform, and eating disorders. In the original study, the average amount of time spent by the physician to administer the clinician evaluation guide to patients who scored positively on the patient questionnaire was 8.4 minutes. However, this is still a considerable amount of time in the primary care setting, where most visits are 15 minutes or less. Therefore, although PRIME-MD has been widely used in clinical research, its use in clinical settings has apparently been limited. This article describes the development, validation, and utility of a fully