Article Figures & Data
Tables
Characteristic No. (%) SCID = Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Sex Women 62 (51.7) Men 58 (48.3) Age, y 15–19 18 (15.0) 20–39 58 (48.3) 40–49 21 (17.5) 50–59 12 (10.0) ≥60 11 (9.2) Marital status Cohabiting 57 (47.5) Single/divorced/widowed 63 (52.5) Education Incomplete junior school 30 (25.0) Complete junior school 28 (23.3) Incomplete or complete high school 51 (42.5) Incomplete or complete bachelor degree/more 11 (9.2) No. of SCID diagnoses 0 76 (63.3) 1 25 (20.8) 2 11 (9.2) 3 8 (6.7) SCID diagnostic category Depressive disorders 25 (20.8) Anxiety disorders 21 (17.5) Substance abuse/dependence 7 (5.8) Somatoform disorders 5 (4.2) Eating disorders 3 (2.5) Adjustment disorders 3 (2.5) Psychotic disorders 1 (0.8) - Table 2.
Area Under the ROC Curve (95% Confidence Interval) for the Questionnaires Studieda
Questionnaire Any Mental Disorder Depressive Disorders Anxiety Disorders Substance Abuse/ Dependence COOP/WONCA = Dartmouth Primary Care Cooperative Research Network, and World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians; ROC = receiver operating characteristic; SRQ-20 = 20-item Self-Reporting Questionnaire; WHO-5 = World Health Organization–Five Well-Being Index. a Reference standard was diagnosis of the disorders by SCID, the Structured Clinical Interview for the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). b Total score using all 6 items. c Feelings, Daily Activities, and Social Activities. SRQ-20 0.93 (0.87–0.97) 0.86 (0.79–0.93) 0.78 (0.70–0.87) 0.72 (0.60–0.84) WHO-5 0.90 (0.85–0.96) 0.83 (0.75–0.91) 0.76 (0.66–0.86) 0.67 (0.52–0.81) COOP/WONCA Chartsb 0.89 (0.82–0.95) 0.81 (0.73–0.90) 0.82 (0.74–0.91) 0.76 (0.51–0.96) Charts item Feelings 0.88 (0.81–0.94) 0.80 (0.71–0.89) 0.79 (0.70–0.89) 0.74 (0.62–0.85) Daily Activities 0.80 (0.72–0.88) 0.80 (0.72–0.88) 0.70 (0.59–0.81) 0.73 (0.54–0.92) Overall Health 0.79 (0.71–0.86) 0.75 (0.65–0.85) 0.80 (0.70–0.90) 0.73 (0.35–0.77) Social Activities 0.78 (0.70–0.87) 0.72 (0.61–0.84) 0.81 (0.71–0.90) 0.77 (0.58–0.96) Physical Fitness 0.63 (0.53–0.73) 0.58 (0.46–0.70) 0.57 (0.44–0.70) 0.63 (0.38–0.88) Change in Health 0.54 (0.43–0.65) 0.49 (0.35–0.63) 0.50 (0.36–0.65) 0.56 (0.31–0.81) Charts 3-item combinationc 0.91 (0.85–0.96) 0.84 (0.77–0.92) 0.82 (0.74–0.91) 0.79 (0.63–0.96) - Table 3.
Cutoff Scores and Performances of the Questionnaires for Screening for Any Mental Disordera
Questionnaire Cutoff Scoreb Total Accuracy Sensitivity Specificity PPV NPV COOP/WONCA = Dartmouth Primary Care Cooperative Research Network, and World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians; NPV = negative predictive value; PPV = positive predictive value; ROC = receiver operating characteristic; SRQ-20 = 20-item Self-Reporting Questionnaire; WHO-5 = World Health Organization–Five Well-Being Index. a Reference standard was diagnosis of the disorders by SCID, the Structured Clinical Interview for the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). b Cutoff scores were chosen based on the scores having the highest total accuracy. c Total score using all 6 items. d Feelings, Daily Activities, and Social Activities. SRQ-20 8 0.85 0.81 0.86 0.78 0.89 WHO-5 11 0.85 0.77 0.89 0.81 0.87 COOP/WONCA Chartsc 17 0.87 0.84 0.88 0.80 0.91 Charts item Feelings 3 0.85 0.84 0.86 0.77 0.90 Daily Activities 2 0.74 0.91 0.64 0.60 0.92 Social Activities 3 0.76 0.59 0.86 0.70 0.78 Overall Health 5 0.72 0.64 0.82 0.67 0.80 Charts 3-item combinationd 9 0.87 0.86 0.88 0.81 0.92
Additional Files
The Article in Brief
COOP/WONCA Charts as a Screen for Mental Disorders in Primary Care
Joao Mazzoncini de Azevedo-Marques , and colleagues
Background Questionnaires can be used to facilitate the screening of mental disorders in the primary care setting. This study evaluates the validity and feasibility of the COOP/WONCA Charts, a brief 6-item pictorial assessment for routine screening of mental disorders, by comparing it with other validated questionnaires and the assessment of a mental health specialist using structured diagnostic interview.
What This Study Found The COOP/WONCA Charts is valid and feasible for use by primary health care teams in screening for mental disorders. When administered to 120 primary care patients, the tool had accuracy, sensitivity, specificity, and predictive values ranging between 0.77 and 0.92 compared with previously validated questionnaires. Clinicians who administered the questionnaires rated its understandability, ease of use, and clinical relevance as satisfactory.
Implications
- Because the tool is friendly, brief, easily understood and can be administered and scored by all team members, it is a useful screening tool for the primary care setting, where there are many competing demands and time constraints.
