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Research ArticleMethodology

Feasibility and Diagnostic Validity of the M-3 Checklist: A Brief, Self-Rated Screen for Depressive, Bipolar, Anxiety, and Post-Traumatic Stress Disorders in Primary Care

Bradley N. Gaynes, Joanne DeVeaugh-Geiss, Sam Weir, Hongbin Gu, Cora MacPherson, Herbert C. Schulberg, Larry Culpepper and David R. Rubinow
The Annals of Family Medicine March 2010, 8 (2) 160-169; DOI: https://doi.org/10.1370/afm.1092
Bradley N. Gaynes
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Joanne DeVeaugh-Geiss
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Sam Weir
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Hongbin Gu
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Cora MacPherson
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Herbert C. Schulberg
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Larry Culpepper
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David R. Rubinow
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Abstract

PURPOSE Mood and anxiety disorders are the most common psychiatric conditions seen in primary care, yet they remain underdetected and undertreated. Screening tools can improve detection, but available instruments are limited by the number of disorders assessed. We wanted to assess the feasibility and diagnostic validity of the My Mood Monitor (M-3) checklist, a new, 1-page, patient-rated, 27-item tool developed to screen for multiple psychiatric disorders in primary care.

METHODS We enrolled a sample of 647 consecutive participants aged 18 years and older who were seeking primary care at an academic family medicine clinic between July 2007 and February 2008. We used a 2-step scoring procedure to make screening more efficient. The main outcomes measured were the sensitivity and specificity of the M-3 for major depression, bipolar disorder, any anxiety disorder, and post-traumatic stress disorder (PTSD), a specific type of anxiety disorder. Using a split sample technique, analysis proceeded from determination of optimal screening thresholds to assessment of the psychometric properties of the self-report instrument using the determined thresholds. We used the Mini International Neuropsychiatric Interview as the diagnostic standard. Feasibility was assessed with patient and physician exit questionnaires.

RESULTS The depression module had a sensitivity of 0.84 and a specificity of 0.80. The bipolar module had a sensitivity of 0.88, and a specificity of 0.70. The anxiety module had a sensitivity of 0.82 and a specificity of 0.78, and the PTSD module had a sensitivity of 0.88 and a specificity of 0.76. As a screen for any psychiatric disorder, sensitivity was 0.83 and specificity was 0.76. Patients took less than 5 minutes to complete the M-3 in the waiting room, and less than 1% reported not having time to complete it. Eighty-three percent of clinicians reviewed the checklist in 30 or fewer seconds, and 80% thought it was helpful in reviewing patients’ emotional health.

CONCLUSIONS The M-3 demonstrates utility as a valid, efficient, and feasible tool for screening multiple common psychiatric illnesses, including bipolar disorder and PTSD, in primary care. Its diagnostic accuracy equals that of currently used single-disorder screens and has the additional benefit of being combined into a 1-page tool. The M-3 potentially can reduce missed psychiatric diagnoses and facilitate proper treatment of identified cases.

  • Mental health
  • health promotion
  • disease prevention
  • mass screening
  • depression
  • anxiety disorder
  • bipolar disorder
  • stress disorders, post-traumatic
  • primary health care
  • Received for publication April 3, 2009.
  • Revision received July 29, 2009.
  • Accepted for publication August 18, 2009.
  • © 2010 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 8 (2)
The Annals of Family Medicine: 8 (2)
Vol. 8, Issue 2
1 Mar 2010
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Feasibility and Diagnostic Validity of the M-3 Checklist: A Brief, Self-Rated Screen for Depressive, Bipolar, Anxiety, and Post-Traumatic Stress Disorders in Primary Care
Bradley N. Gaynes, Joanne DeVeaugh-Geiss, Sam Weir, Hongbin Gu, Cora MacPherson, Herbert C. Schulberg, Larry Culpepper, David R. Rubinow
The Annals of Family Medicine Mar 2010, 8 (2) 160-169; DOI: 10.1370/afm.1092

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Feasibility and Diagnostic Validity of the M-3 Checklist: A Brief, Self-Rated Screen for Depressive, Bipolar, Anxiety, and Post-Traumatic Stress Disorders in Primary Care
Bradley N. Gaynes, Joanne DeVeaugh-Geiss, Sam Weir, Hongbin Gu, Cora MacPherson, Herbert C. Schulberg, Larry Culpepper, David R. Rubinow
The Annals of Family Medicine Mar 2010, 8 (2) 160-169; DOI: 10.1370/afm.1092
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