Diagnostic Accuracy of the Primary Care Screener for Affective Disorder (PC-SAD) in Primary Care
Angelo Picardi1, *, D.A Adler2, 3, 4, W.H Rogers2, I Lega1, M.P Zerella5, G Matteucci5, L Tarsitani5, M Caredda5, A Gigantesco1, M Biondi5, the SET-DEP Group
1 Mental Health Unit, Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy
2 The Health Institute, Institute of Clinical Research and Health Policy Studies, Department of Medicine, Tufts Medical Center (Tufts MC), Boston, MA, USA
3 Tufts University School of Medicine, Boston, USA
4 Department of Psychiatry, Tufts MC, Boston, MA, USA
5 Department of Psychiatric Sciences and Psychological Medicine, ‘Sapienza’ University of Rome, Rome, Italy
Depression goes often unrecognised and untreated in non-psychiatric medical settings. Screening has recently gained acceptance as a first step towards improving depression recognition and management. The Primary Care Screener for Affective Disorders (PC-SAD) is a self-administered questionnaire to screen for Major Depressive Disorder (MDD) and Dysthymic Disorder (Dys) which has a sophisticated scoring algorithm that confers several advantages. This study tested its performance against a ‘gold standard’ diagnostic interview in primary care.
A total of 416 adults attending 13 urban general internal medicine primary care practices completed the PC-SAD. Of 409 who returned a valid PC-SAD, all those scoring positive (N=151) and a random sample (N=106) of those scoring negative were selected for a 3-month telephone follow-up assessment including the administration of the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) by a psychiatrist who was masked to PC-SAD results.
Most selected patients (N=212) took part in the follow-up assessment. After adjustment for partial verification bias the sensitivity, specificity, positive and negative predictive value for MDD were 90%, 83%, 51%, and 98%. For Dys, the corresponding figures were 78%, 79%, 8%, and 88%.
While some study limitations suggest caution in interpreting our results, this study corroborated the diagnostic validity of the PC-SAD, although the low PPV may limit its usefulness with regard to Dys. Given its good psychometric properties and the short average administration time, the PC-SAD might be the screening instrument of choice in settings where the technology for computer automated scoring is available.
Keywords: : Depression, Diagnosis, Primary care, Public health.
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* Address correspondence to this author at the Italian National Institute of Health, Centre of Epidemiology, Surveillance, and Health Promotion, Mental Health Unit, Viale Regina Elena, 299 - 00161 Rome, Italy;
Tel: +39 06 49904200; Fax: +39 06 49904182; E-mail firstname.lastname@example.org$The SET-DEP Group includes: A. Picardi. M. Biondi, M. Cerbo, A. Gaddini,
A. Gigantesco, F. Spandonaro. M. Caredda, A. Cavallo, A. Crescenzi, I.
Lega, G. Matteucci, B. Polistena, L. Tarsitani, M.P. Zerella. I. Berardelli, I.
Cascavilla, D. Del Re, C. Fini, L. Leoncini. S. Baccarini, F. D’Andrea, M.
Di Fonso, R. Dolfi, A. Guerani, D. Mandolini, G. Marri, L. Pagano, M.
Pagliarini, M.L. Paoletti, A. Pes, S. Raspa, M. Sabatini, U. Salomone, P.