A Diagnostic Aid For Detecting Multiple Mental Disorders In Primary Care: The Symptom Driven Diagnostic System For Primary Care (sdds-pc*).

A high rate of undiagnosed mental disorders in primary care has been well documented for nearly three decades. (Shepherd et al 1966; Regier et al 1978,1993; Goldberg et al 1980; Van Hermert et al 1993; Olfson and Klerman, 1992; Barrett et al 1988). Failure to recognize mental illness has been shown to lead to undertreatment, greater impairment, and a longer duration of illness (Ormel et al 1991). The few efforts to change the diagnostic practice of primary care physicians, either through providing information from a patient screen completed prior to the physician visit or through physician education, have provided equivocal results. (Higgins 1994; Rand et al 1988; Goldberg 1980). The effects of improved physician recognition on decreasing patients’ health care use have also been equivocal, probably because there are many steps between recognition and patient outcome. These steps include accurate diagnosis, proper treatment, patient compliance, and timely follow-up with adjustment in treatment, as needed. Efforts to improve detection of mental disorders have concentrated on developing patient screens, which usually includea list ofpsychiatric symptoms independent of specific diagnoses, (Goldberg et al 1980; Borgquist et al 1993; Von Korff et al 1987) or which screen for one diagnosis; depression or alcoholism (Selzer 1971; Babor et al 1992). The former approach is limited because symptoms are not directly related to a treatable disorder, the latter, because patients may have more than one treatable psychiatric disorder (Kessler et al 1994). Moreover, screens are not widely used in primary care (Nelson and Berwick, 1989). Because most primary care visits are 15 minutes long or less, there is a need to develop rapid assessment methods that can be incorporated into routine care (Barrett 1991; Mitchell et al 1988; Anderson and Mattsson 1989)