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BMC Family Practice

, 13:104

Epidemiology and research methodology in primary care

Abstract

BackgroundThe Provisional Diagnostic Instrument PDI-4 is a brief, adult self-report instrument for 4 common psychiatric diagnoses in primary care patients: major depressive episode MDE, generalized anxiety disorder GAD, attention deficit hyperactivity disorder ADHD, and bipolar I disorder based on past or present mania. Our objective was to assess validity of the PDI-4 in a population independent of the study population originally used to develop the scale.

MethodsAn online version of the 17-item PDI-4 was administered to 1,047 adults in the US; respondents also completed the PHQ-9, HADS-A, CAARS-S, and MDQ within the online survey. Respondents self-reported diagnosis by a healthcare professional with the terms depression n=221, anxiety n=218, attention deficit disorder n=206, bipolar or manic depressive disorder n=195, or none of these n=207. Statistical analyses examined convergent and discriminant validity, and operating characteristics of the PDI-4 relative to the individual, validated, self-rated scales PHQ-9, HADS-A, CAARS-S, and MDQ, for each PDI-4 diagnosis.

ResultsConvergent validity of the PDI-4 was supported by strong correlations with the corresponding individual scales range of 0.63 PDI-4 and MDQ to 0.87 PDI-4 and PHQ-9. Operating characteristics of the PDI-4 were similar to results in the previous site-based study. The scale exhibited moderate sensitivities 0.52 mania to 0.70 ADHD and strong specificities 0.86 mania to 0.92 GAD using the individual scales as the gold standards. ANOVAs demonstrated that PDI-4 discriminated between subsets of patients defined by pre-specified severity level cutoff scores of the individual scales. However, overlapping symptoms and co-morbidities made differentiation between mental diagnoses much weaker than differentiation from the control group with none of the diagnoses.

ConclusionsThe PDI-4 appears to be a suitable, brief, self-rated tool for provisional diagnoses of common mental disorders. However, the high level of symptom overlap between these diagnoses emphasizes that such brief scales are not a replacement for thorough diagnostic evaluation by trained medical providers.

KeywordsCross validation Diagnostic instrument Anxiety Depression Hyperactivity Mania Electronic supplementary materialThe online version of this article doi:10.1186-1471-2296-13-104 contains supplementary material, which is available to authorized users.

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Autor: Douglas E Faries - John P Houston - Ellen M Sulcs - Ralph W Swindle

Fuente: https://link.springer.com/



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