Diagnostic errors of primary care screens for depression and panic disorder

Objective: As the health care reimbursement system has changed, brief scree ns for detecting mental disorders in primary care have been developed. Thes e efforts have faced the formidable task of identifying patients with menta l disorders, while at the same time minimizing the number of misclassifIed cases. Here we consider the balance between sensitivity and positive predic tive value. Primary care patients with false positive and false negative re sults on screens for depression and panic disorder are compared with regard to comorbidity and functional impairment. Methods: This was a cross-sectio nal psychometric study. The study sample included 1001 primary care patient s from the Department of Internal Medicine at Kaiser Permanente in Oakland, California. The Symptom-Driven Diagnostic System for Primary Care (SDDS-PC ) screens and Sheehan Disability Scale were completed by the subjects. The SDDS-PC diagnostic interviews were administered to all subjects. Results: P atients with false positive results on the panic disorder screen did not di ffer from patients with false negatives results with regard to rates of oth er psychiatric disorders, functional impairment, or mental health service u tilization. In contrast, patients with false negative depression screen res ults had significantly more psychiatric disorders and functional impairment than those with false positive depression results. Conclusions: A substant ial number of patients with either false positive or false negative screen results met diagnostic criteria for other mental disorders. Given the nomin al burden of follow-up assessments for patients with positive screens, thes e data suggest that erring on the side of sensitivity may have been prefera ble when algorithms for these screens were selected.