Screening high-risk patients and assisting in diagnosing anxiety in primary care

The patient health questionnaire evaluated

A.D.T. Muntingh, E.W. de Heer, H.W.J. van Marwijk, H.J. Adèr, A.J. van Balkom, P. Spinhoven, C.M. van der Feltz-Cornelis

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Abstract

Background
Questionnaires may help in detecting and diagnosing anxiety disorders in primary care. However, since utility of these questionnaires in target populations is rarely studied, the Patient Health Questionnaire anxiety modules (PHQ) were evaluated for use as: a) a screener in high-risk patients, and/or b) a case finder for general practitioners (GPs) to assist in diagnosing anxiety disorders.
Methods
A cross-sectional analysis was performed in 43 primary care practices in the Netherlands. The added value of the PHQ was assessed in two samples: 1) 170 patients at risk of anxiety disorders (or developing them) according to their electronic medical records (high-risk sample); 2) 141 patients identified as a possible ‘anxiety case’ by a GP (GP-identified sample). All patients completed the PHQ and were interviewed using the Mini International Neuropsychiatric interview to classify DSM-IV anxiety disorders. Psychometric properties were calculated, and a logistic regression analysis was performed to assess the diagnostic value of the PHQ.
Results
Using only the screening questions of the PHQ, the area under the curve was 83% in the high-risk sample. In GP-identified patients the official algorithm showed the best characteristics with an area under the curve of 77%. Positive screening questions significantly increased the odds of an anxiety disorder diagnosis in high-risk patients (odds ratio = 23.4; 95% confidence interval 6.9 to 78.8) as did a positive algorithm in GP-identified patients (odds ratio = 13.9; 95% confidence interval 3.8 to 50.6).
Conclusions
The PHQ screening questions can be used to screen for anxiety disorders in high-risk primary care patients. In GP-identified patients, the benefit of the PHQ is less evident.
Keywords: Anxiety disorder, Patient health questionnaire, Primary care, ScreeningCase finding, Criterion validity
Original languageEnglish
Article number192
JournalBMC Psychiatry
Volume13
DOIs
Publication statusPublished - 2013

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General Practitioners
Area Under Curve
Surveys and Questionnaires
Odds Ratio
Confidence Intervals
Electronic Health Records
Diagnostic and Statistical Manual of Mental Disorders
Netherlands
Cross-Sectional Studies
Logistic Models
Interviews

Cite this

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title = "Screening high-risk patients and assisting in diagnosing anxiety in primary care: The patient health questionnaire evaluated",
abstract = "BackgroundQuestionnaires may help in detecting and diagnosing anxiety disorders in primary care. However, since utility of these questionnaires in target populations is rarely studied, the Patient Health Questionnaire anxiety modules (PHQ) were evaluated for use as: a) a screener in high-risk patients, and/or b) a case finder for general practitioners (GPs) to assist in diagnosing anxiety disorders.MethodsA cross-sectional analysis was performed in 43 primary care practices in the Netherlands. The added value of the PHQ was assessed in two samples: 1) 170 patients at risk of anxiety disorders (or developing them) according to their electronic medical records (high-risk sample); 2) 141 patients identified as a possible ‘anxiety case’ by a GP (GP-identified sample). All patients completed the PHQ and were interviewed using the Mini International Neuropsychiatric interview to classify DSM-IV anxiety disorders. Psychometric properties were calculated, and a logistic regression analysis was performed to assess the diagnostic value of the PHQ.ResultsUsing only the screening questions of the PHQ, the area under the curve was 83{\%} in the high-risk sample. In GP-identified patients the official algorithm showed the best characteristics with an area under the curve of 77{\%}. Positive screening questions significantly increased the odds of an anxiety disorder diagnosis in high-risk patients (odds ratio = 23.4; 95{\%} confidence interval 6.9 to 78.8) as did a positive algorithm in GP-identified patients (odds ratio = 13.9; 95{\%} confidence interval 3.8 to 50.6).ConclusionsThe PHQ screening questions can be used to screen for anxiety disorders in high-risk primary care patients. In GP-identified patients, the benefit of the PHQ is less evident.Keywords: Anxiety disorder, Patient health questionnaire, Primary care, ScreeningCase finding, Criterion validity",
author = "A.D.T. Muntingh and {de Heer}, E.W. and {van Marwijk}, H.W.J. and H.J. Ad{\`e}r and {van Balkom}, A.J. and P. Spinhoven and {van der Feltz-Cornelis}, C.M.",
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Screening high-risk patients and assisting in diagnosing anxiety in primary care : The patient health questionnaire evaluated. / Muntingh, A.D.T.; de Heer, E.W.; van Marwijk, H.W.J.; Adèr, H.J.; van Balkom, A.J.; Spinhoven, P.; van der Feltz-Cornelis, C.M.

In: BMC Psychiatry, Vol. 13, 192, 2013.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Screening high-risk patients and assisting in diagnosing anxiety in primary care

T2 - The patient health questionnaire evaluated

AU - Muntingh, A.D.T.

AU - de Heer, E.W.

AU - van Marwijk, H.W.J.

AU - Adèr, H.J.

AU - van Balkom, A.J.

AU - Spinhoven, P.

AU - van der Feltz-Cornelis, C.M.

N1 - >2000 woorden

PY - 2013

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N2 - BackgroundQuestionnaires may help in detecting and diagnosing anxiety disorders in primary care. However, since utility of these questionnaires in target populations is rarely studied, the Patient Health Questionnaire anxiety modules (PHQ) were evaluated for use as: a) a screener in high-risk patients, and/or b) a case finder for general practitioners (GPs) to assist in diagnosing anxiety disorders.MethodsA cross-sectional analysis was performed in 43 primary care practices in the Netherlands. The added value of the PHQ was assessed in two samples: 1) 170 patients at risk of anxiety disorders (or developing them) according to their electronic medical records (high-risk sample); 2) 141 patients identified as a possible ‘anxiety case’ by a GP (GP-identified sample). All patients completed the PHQ and were interviewed using the Mini International Neuropsychiatric interview to classify DSM-IV anxiety disorders. Psychometric properties were calculated, and a logistic regression analysis was performed to assess the diagnostic value of the PHQ.ResultsUsing only the screening questions of the PHQ, the area under the curve was 83% in the high-risk sample. In GP-identified patients the official algorithm showed the best characteristics with an area under the curve of 77%. Positive screening questions significantly increased the odds of an anxiety disorder diagnosis in high-risk patients (odds ratio = 23.4; 95% confidence interval 6.9 to 78.8) as did a positive algorithm in GP-identified patients (odds ratio = 13.9; 95% confidence interval 3.8 to 50.6).ConclusionsThe PHQ screening questions can be used to screen for anxiety disorders in high-risk primary care patients. In GP-identified patients, the benefit of the PHQ is less evident.Keywords: Anxiety disorder, Patient health questionnaire, Primary care, ScreeningCase finding, Criterion validity

AB - BackgroundQuestionnaires may help in detecting and diagnosing anxiety disorders in primary care. However, since utility of these questionnaires in target populations is rarely studied, the Patient Health Questionnaire anxiety modules (PHQ) were evaluated for use as: a) a screener in high-risk patients, and/or b) a case finder for general practitioners (GPs) to assist in diagnosing anxiety disorders.MethodsA cross-sectional analysis was performed in 43 primary care practices in the Netherlands. The added value of the PHQ was assessed in two samples: 1) 170 patients at risk of anxiety disorders (or developing them) according to their electronic medical records (high-risk sample); 2) 141 patients identified as a possible ‘anxiety case’ by a GP (GP-identified sample). All patients completed the PHQ and were interviewed using the Mini International Neuropsychiatric interview to classify DSM-IV anxiety disorders. Psychometric properties were calculated, and a logistic regression analysis was performed to assess the diagnostic value of the PHQ.ResultsUsing only the screening questions of the PHQ, the area under the curve was 83% in the high-risk sample. In GP-identified patients the official algorithm showed the best characteristics with an area under the curve of 77%. Positive screening questions significantly increased the odds of an anxiety disorder diagnosis in high-risk patients (odds ratio = 23.4; 95% confidence interval 6.9 to 78.8) as did a positive algorithm in GP-identified patients (odds ratio = 13.9; 95% confidence interval 3.8 to 50.6).ConclusionsThe PHQ screening questions can be used to screen for anxiety disorders in high-risk primary care patients. In GP-identified patients, the benefit of the PHQ is less evident.Keywords: Anxiety disorder, Patient health questionnaire, Primary care, ScreeningCase finding, Criterion validity

U2 - 10.1186/1471-244X-13-192

DO - 10.1186/1471-244X-13-192

M3 - Article

VL - 13

JO - BMC Psychiatry

JF - BMC Psychiatry

SN - 1471-244X

M1 - 192

ER -