Health> Vol.5 No.3A, March 2013

Case-finding for mental distress in primary health care: An evaluation of the performance of a five-item screening instrument

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Background: There is an increased interest in developing better and more accurate methods to recognize and manage mental health problems in primary care settings. Abbreviated screening instruments for mental distress are useful tools for research and clinical practice. The present study seeks to investigate whether only a few questionnaire items from the Self-Reporting- Questionnaire-10 (SRQ-10) can be a robust method in the screening for Mental Distress in Primary Health care. Methods: We compared the screening accuracy of a short, five-item (SRQ-5) version of the SRQ-10 with that of the SRQ-20, General Health Questionnaire 12 (GHQ-12) using the DSM-IV axis as a gold standard and analyzed its performance in different diagnostic entities. We also assessed the correlation, sensitivity and specificity between the 4 instruments. All the instruments were administered to 400 primary health care attendees. Results: The estimated prevalence of mental distress was 13.6% in the study sample (Depression 11%, anxiety disorders 1.8%). The SRQ-5 was highly correlated to SRQ-10 (0.923, p < 0.001), SRQ-20 (0.764, p < 0.001) and only moderately correlated to GHQ-12 (0.417, p < 0.001). The SRQ-5 had high properties for identifying mental distress. The AUC for overall mental distress was 0.925 while that for depression and anxiety were 0.915 and 0.849 respectively. Conclusion: This validation showed that in moving from SRQ with 10 or 20 items to one with merely 5 items, we do not seem to lose the screening prowess of the instrument. The SRQ-5 represents a simplified and less time-consuming screening instrument with strong performance characteristics. We therefore recommend it for inclusion into existing patient assessment protocols, thus enhancing case finding at primary health care level.


Cite this paper

Chipimo, P. and Fylkesnes, K. (2013) Case-finding for mental distress in primary health care: An evaluation of the performance of a five-item screening instrument. Health, 5, 627-636. doi: 10.4236/health.2013.53A083.


[1] Goldberg, D. (2000) Distinguishing mental illness in primary care. Mental illness or mental distress? British Medical Journal, 321, 7273. doi:10.1136/bmj.321.7273.1412
[2] Williams, D.R., Herman, A., Stein, D.J., Heeringa, S.G., Jackson, P.B., Moomal, H., et al. (2008) Twelve-month mental disorders in South Africa: Prevalence, service use and demographic correlates in the population-based South African Stress and Health survey. Pschological Medicine, 38, 211-220. doi:10.1017/S0033291707001420
[3] WHO (2001) World health report-mental health: New understanding, new hope. WHO, Geneva.
[4] Giel, R., Gezahegn, Y. and Vann-Luuk, J.N. (1968) Psychiatric morbidity in 200 Ethiopian medical outpatients. Psychiatr Neural Neurochir, 71, 169-176.
[5] Chipimo, P.J. and Fylkesnes, K. (2009) Mental distress in the general population: Impact of HIV and social factors. BMC Public Health, 9, 298.
[6] Kabede, D., Alem, A. and Rashid, E. (1999) The prevalence and socio-demographic correlates of mental distress in Addis Ababa, Ethiopia. Acta Psychiatr Scand, 100, 5- 10. doi:10.1111/j.1600-0447.1999.tb10687.x
[7] Tesfaye, A. (2009) Prevalence and correlates of mental distress among regular undergraduate students of Hawassa University: A cross sectional survey. East African Journal of Public Health, 6, 1. doi:10.4314/eajph.v6i1.45755
[8] Abbo, C., Ekblad, S., Waako, P., Okello, E. and Muhwezi, W.S.M. (2008) Psychological distress and associated factors among attendees of traditional healing practices in Jinja and Iganga districts, Eastern Uganda: A cross-sectional study. International journal of Mental Health Systems, 2, 1-9.
[9] Ngoma, M.C. and Prince, M.A.M. (2003) Common mental disorders among those attending primary health clinics and traditional healers in urban Tanzania. The British Journal of Psychiatry, 183, 349-355. doi:10.1192/bjp.183.4.349
[10] Ciesla, J.A. and Robert, J.E. (2001) Meta-analysis of the relationship between HIV infection and the risk for depressive disorders. American Journal of Psychiatry, 158, 725-730. doi:10.1176/appi.ajp.158.5.725
[11] Jacob, K.S. (2001) Community care for people with mental disorders in developing countries: Problems and possible solutions. The British Journal of Psychiatry, 178, 296-298. doi:10.1192/bjp.178.4.296
[12] Kigozi, F., Ssebunnya, J., Kizza, D., Ndyanabangi, S., Green, A., Omar, M., et al. (2008) A situation analysis of the mental health health system in Uganda: Mental health & poverty project.
[13] Chipimo, P.J. and Fylkesnes, K. (2010) Comparative validity of screening instruments for mental distress in Zam-bia. Clinical Practice & Epidemiology in Mental Health, 6, 4-15. doi:10.2174/1745017901006010004
[14] WHO (1994) A user’s guide to the Self-Reporting Questionnaire. World Health Organisation, Geneva.
[15] Goldberg, D.P., Gater, R., Sartorious, N., et al. (1997) The validity of two versions of GHQ in the WHO study of mental illness in general health care. Psychological Medicine, 27, 191-197. doi:10.1017/S0033291796004242
[16] American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (DSM-IV). 4th Edition, American Psychiatric Association, Washington DC.
[17] Mario, M., Wolfgang, G., Juan-Jose, L. and Norman, S. (2002) Psychiatric diagnosis and classification. 3rd Edition, In: Sons JW, editor..
[18] Rumpf, H., Meyer, C., Hapke, U. and Ulrich, J. (2001) Screening for mental health: Validity of the MHI-5 using DSM-IV Axis I psychiatric disorders as gold standard. Psychiatry Research, 105, 243-253. doi:10.1016/S0165-1781(01)00329-8
[19] Jacobsen, B.K., Hasvold, G., Hansen, H. and Hansen, V. (1995) The general health questionnaire: How many items are really necessary in population surveys? Psychological Medicine, 25, 957-961. doi:10.1017/S0033291700037442
[20] Friedman, B., Heisel, M. and Delavan, R. (2005) Validity of the SF-36 five-item mental health index for major depression in functionally im-paired, community-dwelling elderly patients. Journal of Amer-ican Geriatrics Society, 53, 1978-1985. doi:10.1111/j.1532-5415.2005.00469.x
[21] Berwick, D.M., Murphy, J.M., Goldman, A., Ware, J.E., Barsky, A.J. and Weinsten, M.C. (1991) Performance of a five-item mental health screening test. Medical Care, 29, 169-176. doi:10.1097/00005650-199102000-00008
[22] Cleary, P.D., Bush, B.T. and Kessler, L.G. (1987) Evaluating the use of mental health screening scales in primary care setting using receiver operating characteristics curves. Medical Care, 25, S90-S98. doi:10.1097/00005650-198712001-00009
[23] Mari, J. and Williams, P.A. (1986) Validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of Sao Paulo. British Journal of Psychiatry, 148, 23-26.doi:10.1192/bjp.148.1.23

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