Health services - Research lines Jordi Alonso

Development of a short questionnaire for assessing depressive and anxiety disorders in general population Health Surveys

Research team: Alonso, J (IP); Herdman, M; Pinto, A; Vilagut, G

Background: Several brief (5-20 min) questionnaires are available designed to provide an overall evaluation of mental disorders, assessing large diagnostic categories such as affective disorders and mood disorders. These questionnaires are frequently used as screening instruments. The most widely used examples are the Mental Health Inventory (MHI; 38-, 18-, and 5-items versions), the General Health Questionnaire (GHQ; 60-, 30-, 28-, and 12-items versions), the Brief Symptom Inventory (BSI; 53 items), and the Center for Epidemiological Studies Depression Scale (CES-D; 20- and 18-items versions). Despite their popularity, the lack of specificity of these instruments restricts its usefulness in National Health Surveys. Consequently, the need still exists for a brief diagnostic instrument to be developed, with good psychometric properties and able to provide more accurate diagnostic estimates.

Objectives: To develop and evaluate a short questionnaire, in Spanish, designed to elicit psychiatric diagnoses (i.e., depressive and anxiety disorders) to be included in Health Surveys. To conduct a systematic bibliographic review with meta-analysis of publications about the validation of instruments of screening of mental disorders, in order to compare the results with those obtained with the new instrument.

Methods: 1. Systematic review with meta-analysis of mental disorders screening questionnaires; 2. Analyses of the ESEMeD data (n=21425) in order to identify the CIDI 3.0 items (specifically, those in the screening section and in some specific sections, e. g., K10) that are more efficient in eliciting key psychological symptoms for diagnosing mental disorders; and development of a short questionnaire for the assemssment of depressive and anxiety disorders from these items selected. Calibration of the new instrument in relation with the DSM-IV diagnostic obtained with the CIDI 3.0, the results of the meta-analysis and the results of the clinical reappraisal conducted in a subsample of ESEMeD respondents.

Status: We have conducted a systematic search of articles indexed in PubMed (from 1990 to 2009), indentifying 2,036 articles. Currently the selection of articles is being carried out, according to specific inclusion criteria and through the inspection of titles and summaries. We have studied the unidimensionality and the predictive value of the variables included in the K10 (Kessler, 2003), and included in the general health survey SF-12 (Ware et al., 1995), applying different thresholds for the diagnostics of any mood disorder, any anxiety disorder, and any 12-month mental disorder in the ESEMeD sample.

Keywords: Screening, validation, mental disorders

Funding: Instituto de Salud Carlos III FEDER (PI 08/90724).