PRIME-MD - ITS UTILITY IN DETECTING MENTAL-DISORDERS IN AMERICAN-INDIANS

Objective: To examine the utility of using PRIME-MD (Primary Care Eval uation of Mental Disorders) for diagnosing mental disorders in America n Indians. Method: One hundred randomly selected, adult, American-Indi an patients who receive health care services at an urban Indian Health Service primary care clinic were evaluated for mental disorder by thr ee primary care physicians using the PRIME-MD diagnostic assessment pr ocedure. The main outcome measures were PRIME-MD diagnoses, diagnoses by an independent mental health professional, and treatment/referral d ecisions. Results: Eighteen percent of the patients had a threshold (m et full DSM-IV criteria) PRIME-MD diagnosis, and an additional 17 perc ent had a subthreshold PRIME-MD diagnosis. The most frequently occurri ng PRIME-MD diagnoses were: probable alcohol abuse/dependence, major d epressive disorder, and generalized anxiety disorder. Over 60 percent of the patients with a PRIME-MD diagnosis who were known ''somewhat'' or ''fairly well'' to their physician had not been recognized as havin g that psychiatric disorder prior to the PRIME-MD assessment. Therapy and/or referral was initiated for nineteen of the twenty-seven patient s with a PRIME-MD diagnosis who were not previously receiving treatmen t. The primary care physicians were able to complete the PRIME-MD eval uations within an average of 7.8 minutes. There was a fair agreement b etween the PRIME-MD diagnoses and the diagnoses of the mental health p rofessional (kappa = 0.56; overall accuracy rate = 79%). Conclusions: The present study represents the first formal examination of the use o f PRIME-MD with American Indians, The results are encouraging. Further studies using PRIME-MD with other urban groups and reservation popula tions are recommended.