Brief screening for family psychiatric history - The family history screen

Background: Brief screens to collect lifetime family psychiatric history ar e useful in clinical practice and for identifying potential families for ge netic studies. Methods: The Family History Screen (FHS) collects information on 15 psychia tric disorders and suicidal behavior in informants and their first-degree r elatives. Since each question is posed only once about all family members a s a group, the administrative time is 5 to 20 minutes, depending on family size and illness. Data on the validity against best-estimate (BE) diagnosis based on independent and blind direct interviews on 289 probands and 305 r elatives and test-retest reliability across 15 months in 417 subjects are p resented. Results: Agreement between FHS and BE diagnosis for proband and relative se lf-report had median sensitivity (SEN) of 67.6 and 71.1 respectively; media n specificity (SPC) was 87.6 and 89.4, respectively. Marked decrease in SEN occurred when a single informant (the proband) reported on a relative (med ian, 37.5); however, median SPC was 95.8. Use of more than 1 informant subs tantially improved SEN (median, 68.2), with a modest reduction in SPC (medi an, 86.8). Test-retest reliability across 15 months resulted in a median ka ppa of 0.56. Conclusions: The FHS is a promising brief screen for collecting lifetime ps ychiatric history on an informant and/or first-degree relatives. Its validi ty is best demon strated for major depression, anxiety disorders, substance dependence (alcohol and drug dependence), and suicide attempts. It is not a substitute for more lengthy family history if more detail on diagnosis is required.