Use of the Health History as a Psychiatric Screening Tool

Background: Numerous studies indicate that most mental health services are provided in the primary care medical setting and that problems exist with misdiagnoses and lack of recognition of mental health disorders. The purpose of our investigation was to determine whether patient responses on a typical medical health history form could be used to predict depression or anxiety. Methods: New adult patients at a university community family practice clinic were surveyed during a 6-month period. Study patients completed a health history form and standardized inventories of anxiety and depression. Results: The study sample included 187 patients. Positive responses to mood-related symptoms reported on the health history best predicted anxiety and depression. Nonmood symptoms were also significant, although not as powerful, predictors of these disorders. A significant relation existed between total number of positive symptoms and psychiatric diagnoses, which continued when mood symptoms were removed from the analyses. Results were used to develop physical, nonmood primary care symptom profiles that could be used to screen for anxiety and depression. Conclusion: Providing physicians the means to improve mental health diagnostics can help advance patient care and health care system outcomes. (J Am Board Fam Pract 1998;11:452-8.