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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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  • Figure 1.
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    Figure 1.

    Summary of 224 participants with a diagnosis by MINI.

    Note: No mood or anxiety disorder = 423 (65.4%).

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    Table 1.

    Baseline Characteristics of the Study Sample

    Diagnosis by MINI
    CharacteristicNo Disorder n=423 (65.4%)Depression Without Anxiety n=27 (4.2%)Depression With Anxiety n=78 (12.1%)Bipolar Disorder n=60 (9.3%)Anxiety Without Depression n=59 (9.1%)Total N=647
    GED = general equivalency diploma; MINI = Mini International Neuropsychiatric Interview.
    a Employment status, marital status, education, and income were not collected on the first 99 participants. For all variables, percentages were calculated for participants with available data.
    Mean age (SD) [range], y46.4 (16.6) [18–92]44.9 (14.6) [19–70]45.0 (12.4) [19–70]41.2 (10.7) [18–63]41.0 (13.8) [21–72]45.2 (15.4) [18–92]
    Women, %69.585.271.878.366.170.9
    Race, %
        White67.459.365.460.076.366.9
        Black27.440.732.135.018.628.4
        Other5.202.55.05.14.6
    Marital status, %a
        Married53.829.240.026.046.047.8
        Single26.229.224.638.030.027.6
        Divorced9.612.521.514.012.011.8
        Separated1.412.510.82.02.03.1
        Widowed4.28.31.54.02.03.9
        Living with partner4.88.31.516.08.05.9
    Education, %a
        Without high school2.94.46.16.34.13.8
        Diploma or GED30.647.848.554.236.736.2
        High school diploma/GED13.526.118.26.320.414.6
        Associate/technical degree29.413.018.227.126.526.8
        College diploma23.68.79.16.312.218.6
        Graduate degree
    Household’s gross income, %a
        ≤$14,99910.917.431.850.014.317.6
        $15,000–39,99924.639.131.827.126.526.5
        $40,000–59,99911.88.71.58.320.410.8
        ≥60,00040.48.719.74.228.632.2
        Not know/refused12.326.115.210.410.212.9
    Employment status, %a
        Unemployed13.843.535.450.018.421.4
        Employed69.347.847.745.871.463.8
        Retired, not working17.08.716.94.210.214.8
    • View popup
    Table 2.

    M-3 Psychometrics for Specific Diagnoses and for Any Diagnosis by MINI (n = 647)

    Diagnosis by MINI
    Test ResultDepression (n=142)Bipolar (n=60)Anxiety (n=182)PTSD (n=41)Any Diagnosis (n=224)
    CI=confidence interval; LR = likelihood ratio; M-3 = My Mood Monitor checklist; MINI = Mini International Neuropsychiatric Interview; PTSD=post-traumatic stress disorder.
    a If any diagnosis cut-off score was met, the screen was considered positive.
    b Number with a positive screen and who have that diagnosis by MINI/total number with a positive screen by M-3.
    c Number with a negative screen and who do not have that diagnosis by MINI/total number with a negative screen by M-3.
    M-3 subscore cutoff (≥)5232Any positive screena
    Question No.1–720–238–1913–161–23
    Sensitivity (95% CI)0.84 (0.77–0.89)0.88 (0.77–0.95)0.82 (0.75–0.87)0.88 (0.74–0.96)0.83 (0.77–0.88)
    Specificity (95% CI)0.80 (0.76–0.83)0.70 (0.66–0.74)0.78 (0.74–0.81)0.76 (0.73–0.80)0.76 (0.72–0.80)
    Positive LR (95% CI)4.19 (3.47–5.06)2.94 (2.53–3.44)3.65 (3.05–4.39)3.69 (3.08–4.44)3.48 (2.90–4.16)
    Negative LR (95% CI)0.20 (0.14–0.29)0.17 (0.08–0.33)0.23 (0.17–0.32)0.16 (0.07–0.36)0.22 (0.17–0.30)
    Positive M-3 screen, %3435392844
    Diagnosed by MINI, %22928635
    Positive predictive value (95% CI) [n/n]b0.54 (0.47–0.61) [119/220]0.23 (0.18–0.29) [53/229]0.59 (0.53–0.65) [149/253]0.20 (0.15–0.27) [36/180]0.65 (0.59–0.70) [186/287]
    Negative predictive value (95% CI) [n/n]c0.95 (0.92–0.96) [404/427]0.98 (0.96–0.99) [411/418]0.92 (0.88–0.94) [361/394]0.99 (0.97–1.0) [462/467]0.89 (0.86–0.92) [322/360]
    • View popup
    Table 3.

    Comparison of Sensitivity and Specificity of M-3 With Reference Standard Instruments

    OutcomePHQ-942 DepressionMood Disorder Questionnaire43 BipolarCAPS44 PTSDGAD-721 Anxiety
    CAPS = Clinician-Administered PTSD Scale; GAD-7 = 7-item Generalized Anxiety Disorder scale; M-3 = My Mood Monitor checklist; PHQ-9 = 9-item Patient Health Questionnaire; PTSD = post-traumatic stress disorder.
    Note: The sensitivity and specificity for any diagnosis by the M-3 (depression, bipolar, anxiety, or PTSD) was 0.83 and 0.76, respectively.
    Existing instrument
        Sensitivity0.880.730.740.77
        Specificity0.880.900.840.82
    M-3
        Sensitivity0.840.880.880.82
        Specificity0.800.700.760.78

Additional Files

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  • Supplemental Figure

    Supplemental Figure. My Mood Monitor (M-3)checklist.

    Files in this Data Supplement:

    • Supplemental data: Figure - PDF file, 1 page, 87 KB
  • The Article in Brief

    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 , and colleagues

    Background Mood and anxiety disorders are the most common psychiatric conditions seen in primary care, yet they remain underdetected and undertreated. This study tests the M-3 checklist, a new 1-page, patient-rated, 27-item tool developed to screen for multiple psychiatric disorders in primary care.

    What This Study Found A 1-page, 27-item checklist that can be completed in a few minutes accurately indicates whether a patient has any of 4 common psychiatric illnesses, including major depression, bipolar disorder, anxiety disorder, and post-traumatic stress disorder. Testing showed the checklist was as accurate as currently used screening instruments that test for single disorders.

    Implications

    • Primary care clinicians need to consider multiple psychiatric disorders among their patients, rather than just depression or anxiety alone. The M-3 potentially can reduce missed psychiatric diagnoses and facilitate proper treatment of identified cases.
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The Annals of Family Medicine: 8 (2)
The Annals of Family Medicine
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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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