A brief case-finding questionnaire for common mental disorders: the CMDQ.
ABSTRACT The aim of the study was to validate a new case-finding instrument for common mental disorders (CMDQ).
A cross-sectional, stratified, two-phase study was carried out in 28 general practices in Aarhus County, Denmark. 1785 consecutive patients, 18-65 years old, consulting 38 GPs with a new health problem participated. Patients were screened before consultation using a one-page screening questionnaire including subscales for somatisation (SCL-SOM and Whiteley-7), anxiety (SCL-ANX4), depression (SCL-DEP6) and alcohol abuse (CAGE). A stratified subsample of 701 patients was interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) interview. We tested the external validity of the scales using the SCAN interview as gold standard. All data were analysed using appropriate weighted procedures to control for the two-phase sampling design and non-response bias.
Estimates of sensitivity and specificity for relevant ICD-10 diagnoses at theoretical optimal cut-off points on subscales: Depressive disorder: 78/86 (SCL-DEP6); Alcohol abuse or dependence: 78/97 (CAGE); Severe anxiety disorder: 77/85 (SCL-ANX4); Somatisation disorder: 83/56 (SCL-SOM); and 75/52 (Whiteley-7); any mental disorder: 72/72 (SCL-8). At the theoretical optimal cut-off points the CMDQ demonstrated higher diagnostic accuracy than GPs on any diagnosis evaluated.
The study results suggest that the CMDQ has excellent external validity for use as a diagnostic aid in primary care settings.
Article: Depression, anxiety, and somatoform disorders: vague or distinct categories in primary care? Results from a large cross-sectional study.[show abstract] [hide abstract]
ABSTRACT: Depression, anxiety, and somatization are the most frequently observed mental disorders in primary health care. Our main objective was to draw on the often neglected general practitioners' (GPs) perspective to investigate what characterizes these three common mental diagnoses with regard to creating more suitable categories in the DSM-V and ICD-11. We collected independent data from 1751 primary care patients (participation rate=77%) and their 32 treating GPs in Germany. Patients filled out validated patient self-report measures for depression (PHQ-9), somatic symptom severity (PHQ-15), and illness anxiety (Whiteley-7), and questions regarding coping and attribution of illness. GPs' clinical diagnoses and associated features were assessed. Patients diagnosed by their GPs with depression, anxiety, and/or somatoform disorders were significantly older, less educated, and more often female than the reference group not diagnosed with a mental disorder. They had visited the GP more often, had a longer duration of symptoms, and were more often under social or financial stress. Among the mental disorders diagnosed by the GPs, depression (OR=4.4; 95% CI=2.6 to 7.5) and comorbidity of somatoform, depressive, and anxiety disorders (OR=9.5; 95% CI=4.6 to 19.4) were associated with the largest degrees of impairment compared to the reference group. Patients diagnosed as having a somatoform/functional disorder only had mildly elevated impairment on all dimensions (OR=2.0; 95% CI=1.4 to 2.7). Similar results were found for the physicians' attribution of psychosocial factors for cause and maintenance of the disease, difficult patient-doctor relationship, and self-assessed mental disorder. In order to make the DSM-V and ICD-11 more suitable for primary care, we propose providing appropriate diagnostic categories for (1) the many mild forms of mental syndromes typically seen in primary care; and (2) the severe forms of comorbidity between somatoform, depressive, and/or anxiety disorder, e.g., with a dimensional approach.Journal of psychosomatic research 10/2009; 67(3):189-97. · 2.91 Impact Factor
Article: Return to work among employees with common mental disorders: study design and baseline findings from a mixed-method follow-up study.[show abstract] [hide abstract]
ABSTRACT: Most research on return-to-work (RTW) has focused on musculoskeletal disorders. To study RTW in employees sick-listed with common mental disorders (CMD), e.g., stress, depression, and anxiety, the National Research Centre for the Working Environment initiated a study on ''Common Mental Disorders, Return-to-work, and Long-term Sickness Absence'' (CORSA). The aim of the study is (1) to identify predictors of RTW from the environmental, the individual, and the health-related domain and (2) to explore the RTW process based on study participants' experiences. The purpose of this paper is to present the study design and the characteristics of the participants, including analyses on non-response and the prevalence of major depression. CORSA is a mixed-method follow-up study encompassing quantitative and qualitative analyses in a cohort of employees sick-listed with CMD. Participants were all employees who suffered from CMD and whose applications for sickness absence benefits were processed by the Job Centre Copenhagen (a subunit of the municipality) between July and December 2007 (n = 721). Data on predictors for RTW were collected from (1) administrative application forms filled out by all participants when applying for benefits (n = 721), and (2) baseline questionnaires sent to all participants (responders: n = 298). Data on RTW was retrieved from a national sickness absence registry and from 6-month follow-up questionnaires (n = 226). To explore the RTW process we will primarily use data from in-depth interviews with selected participants (n = 16) supplemented with data from the two questionnaires. The mixed method design allows for a more comprehensive understanding of RTW by triangulating qualitative and quantitative methods.Scandinavian Journal of Public Health 12/2010; 38(8):864-72. · 1.39 Impact Factor
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ABSTRACT: Denmark offers COPD rehabilitation to enable patients to tackle the consequences of COPD, but only a minority of the patients complete these programs. To increase the completion rate, an follow-up study was performed, to characterize COPD patients and to identify potential differences between those who complete and those who do not complete rehabilitation or do not even get a rehabilitation offer in daily clinical routine. In- and out COPD-patients who participated in baseline tests were compared in terms of completion of rehabilitation, drop-out, and no rehabilitation offer. We obtained data on basic characteristics, co-morbidity, lung-function (FEV1), dyspnea (MRC), six-minute walkg-distance (6MWD), and quality of life (SF36). The source population counted 521 COPD patients of whom 256 were excluded (diagnosis withdrawn, death, moved away, long-term oxygen, severe illness). Patients who completed rehabilitation had a 15% longer 6MWD than patients not offered rehabilitation and a 10% longer 6MWD than drop-outs despite a significant lower subjective perception of physical function among completers than in the two other groups. Patients not offered rehabilitation had a slightly better lung function than the other two groups. This suggests that lower physical performance with the same (drop-outs) or even higher (not offered) lung function indicates a lower chance of completion. COPD patients who could potentially benefit most from completing rehabilitation seem to be deselected. A mere 9% completed rehabilitation within the study period and 23% ever completed. This demonstrates that the political target that 60% of COPD patients should be offered rehabilitation is still far away.The Clinical Respiratory Journal 02/2011; 5(4):235-44. · 1.06 Impact Factor