A short, psychiatric, case-finding measure for HIV seropositive outpatients: performance characteristics of the 5-item mental health subscale of the SF-20 in a male, seropositive sample.

OBJECTIVES The author assesses performance characteristics of the 5-item mental health scale (MHI-5) of the Medical Outcomes Study Short Form Health Survey when used as a psychiatric case-finding measure for human immunodeficiency virus (HIV) seropositive outpatients. METHODS Ninety-five HIV seropositive outpatients from two primary care practices were recruited and cross-sectionally studied. All subjects completed the MHI-5. Standardized Clinical Interview for DSM-III-R (SCID-NP-HIV) was used as the gold standard in assessing Axis I psychiatric disorders in the previous 6 months. RESULTS Thirty-three of 95 (35%) subjects had Axis I disorders (Axis I): 18 of 33 (55%) had a diagnosis of major depression (MD); 15 of 33 (45%) had another diagnosis (AD). Areas under receiver operator characteristic (ROC) curves were 0.76 (95% confidence interval [CI], 0.65, 0.87; Axis I), 0.84 (95% CI, 0.74, 0.94; MD), and 0.55 (95% CI, 0.38, 0.72; AD). The area under the MD curve was significantly greater than that for the AD curve (P = 0.0017). The optimal subscale score cut-off point on the MD curve was 52. Test characteristics for this cut-off point were: sensitivity, 83%; specificity, 65%; positive predictive value, 36%; negative predictive value, 94%; likelihood ratio for a positive test, 2.37; and likelihood ratio for a negative test, 0.26. CONCLUSIONS The MHI-5 is the first short psychiatric case-finding measure for which performance characteristics have been reported for HIV seropositive outpatients. Test characteristics suggest that it may be a useful case-finding measure for these patients. A positive finding may indicate a diagnosis of recent major depression.

[1]  J. D. Weisman,et al.  Depressed mood and its relationship to neuropsychological test performance in HIV-1 seropositive individuals. , 1992, Journal of clinical and experimental neuropsychology.

[2]  B. Burns,et al.  Mental disorders in primary care: epidemiologic, diagnostic, and treatment research directions. , 1988, General hospital psychiatry.

[3]  M Davies,et al.  The Structured Clinical Interview for DSM-III-R (SCID). II. Multisite test-retest reliability. , 1992 .

[4]  D. Richman,et al.  Prevalence of psychiatric disorders among men infected with human immunodeficiency virus. A controlled study. , 1988, Archives of general psychiatry.

[5]  G. Glosser,et al.  Relationship between psychiatric disease and neuropsychological impairment in HIV seropositive individuals , 1995, Journal of the International Neuropsychological Society.

[6]  J Ormel,et al.  Recognition, management, and course of anxiety and depression in general practice. , 1991, Archives of general psychiatry.

[7]  H. Chuang,et al.  Psychiatric Morbidity in Patients with HIV Infection * , 1992, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[8]  C. Hutelmyer,et al.  Human Immunodeficiency Virus (HIV) Infection and Quality of Life: The Potential Impact of Axis I Psychiatric Disorders in a Sample of 95 HIV Seropositive Men , 1997, Psychosomatic medicine.

[9]  M. Olfson,et al.  Brief diagnostic interviews (SDDS-PC) for multiple mental disorders in primary care. A pilot study. , 1995, Archives of family medicine.

[10]  R. Olshen,et al.  Depressed mood does not explain neuropsychological deficits in HIV-infected persons. , 1993 .

[11]  L. Franco,et al.  The ROC Curve in the Evaluation of Fasting Capillary Blood Glucose as a Screening Test for Diabetes and IGT , 1994, Diabetes Care.

[12]  R M Centor,et al.  A Visicalc Program for Estimating the Area Under a Receiver Operating Characteristic (ROC) Curve , 1985, Medical decision making : an international journal of the Society for Medical Decision Making.

[13]  J. Shea,et al.  SF-20 score and item distributions in a human immunodeficiency virus-seropositive sample. , 1996, Medical care.

[14]  G. R. Brown,et al.  Prevalence of psychiatric disorders in early stages of HIV infection. , 1992, Psychosomatic medicine.

[15]  T. Plasse.  Clinical use of dronabinol. , 1991, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[16]  M. O’Dowd,et al.  Characteristics of patients attending an HIV-related psychiatric clinic. , 1991, Hospital & community psychiatry.

[17]  D. Goldberg,et al.  A scaled version of the General Health Questionnaire , 1979, Psychological Medicine.

[18]  M. Olfson,et al.  Development and validation of the SDDS-PC screen for multiple mental disorders in primary care. , 1995, Archives of family medicine.

[19]  M. Weinstein,et al.  Performance of a Five-Item Mental Health Screening Test , 1991, Medical care.

[20]  K Kroenke,et al.  Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. , 1994, JAMA.

[21]  J. Gorman,et al.  Multidisciplinary baseline assessment of homosexual men with and without human immunodeficiency virus infection. II. Standardized clinical assessment of current and lifetime psychopathology. , 1991, Archives of general psychiatry.

[22]  A. Salazar,et al.  Neuropsychological performance, mood, and complaints of cognitive and motor difficulties in individuals infected with the human immunodeficiency virus. , 1993, The Journal of neuropsychiatry and clinical neurosciences.

[23]  M. Howes,et al.  Primary health care providers' recognition and diagnosis of mental disorders in their patients. , 1988, General hospital psychiatry.

[24]  C. Lyketsos,et al.  Screening for Psychiatric Morbidity in a Medical Outpatient Clinic for HIV Infection: The Need for a Psychiatric Presence , 1994, International journal of psychiatry in medicine.

[25]  M. First,et al.  The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. , 1992, Archives of general psychiatry.

[26]  C. Mulrow,et al.  Case-Finding Instruments for Depression in Primary Care Settings , 1995, Annals of Internal Medicine.