Screening for anxiety, depression, and anxious depression in primary care: A field study for ICD-11 PHC

Abstract Background In this field study of WHO's revised classification of mental disorders for primary care settings, we tested the usefulness of two five-item screening scales for anxiety and depression to be administered in primary care settings. Methods The study was conducted in primary care settings in four large middle-income countries. Primary care physicians (PCPs) referred individuals who they suspected might be psychologically distressed to the study. Screening scales as well as a structured diagnostic interview, the Clinical Interview Schedule, Revised (CIS-R), adapted for proposed decision rules in ICD-11 PHC, were administered to 1,488 participants. Results A score of 3 or more on one or both screening scale predicted 89.6% of above-threshold mood or anxiety disorder diagnoses on the CIS-R. Anxious depression was by far the most common CIS-R diagnosis. However, there was an exact diagnostic match between the screening scales and the CIS-R in only 62.9% of those with high scores. Limitations This study was confined to those in whom the PCP suspected psychological distress, so does not provide information about the prevalence of various mental disorders in primary care settings. Conclusions The two five-item screening scales for anxiety and depression provide a practical way for PCPs to evaluate the likelihood of mood and anxiety disorders without paper and pencil measures that are not feasible in many settings. These scales may provide substantially improved case detection as compared to current primary care practice, and offer a realistic alternative to complex diagnostic algorithms used by specialist mental health professionals.