A clinical predictive score for mood disorder riskin low-income primary care settings

Abstract

Background: Despite availability of validated screening tests for mood disorders, busy general practitioners (GPs) often lack the time to use them routinely.This study aimed to develop asimplified clinical predictive score to help screen for presence of current mood disorder in low-income primary care settings. Methods: In across-sectionalstudy, 197 patients seen at 10 primary care centers in Santiago, Chile completed self-administered screening tolos for mood disorders: the Patient Health question naire (PHQ-9) and the Mood Disorder Questionnaire (MDQ).To determine participants’ current-point mood disorder status,trained clinicians applied agold-standard diagnostic interview (SCID-I).Asimplified clinical predictive model (CM) was developed based on clinical feature sand selected questions from the screening tools.Using CM, a clinical predictive score (PS) was developed. Full PHQ – 9 and GP assessment were compared with PS. Results: Using multivariate logistic regression, clinical and demographic variables predictive of current mood disorder were identified for asimplified 8-point predictive score (PS). PS had better discrimination than GP assessment (auROC-statistic¼0.80 [95%CI0.72,0.85] vs. 0.58 [95%CI0.52,0.62] p-value o0.0001), but not as good as the full PHQ-9 (0.89 [95%CI0.85,0.93], p-value ¼ 0.03). Compared with GP assessment, PS increased sensitivity by 50% ata fixed specificity of 90%. Administered in a typical primary care clinical population, itcorrectly predicted almost 80% of cases. Limitations: Further research must verify external validity of the PS. Conclusion: An easily administered clinical predictive score determined, with reasonable accuracy, the current risk of mood disorders in low-income primary care settings.