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The European Journal of Public Health Advance Access originally published online on January 30, 2009
The European Journal of Public Health 2009 19(3):303-307; doi:10.1093/eurpub/ckn149
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© The Author 2009. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Health Services Research

Test–retest reliability of the PRIME-MD: limitations in diagnosing mental disorders in primary care

Ingrid M. Bakker1,2, Berend Terluin1,2, Harm W. J. van Marwijk1,2, Willem van Mechelen1,3 and Wim A. B. Stalman1,2

1 EMGO Institute, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands
2 Department of General Practice, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands
3 Department of Public and Occupational Health, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands

Correspondence: Ingrid M. Bakker, Public Health and Society, Wageningen University, P.O. Box 8060, 6700 DA Wageningen, The Netherlands, tel: + 31 317 48 25 09, fax: +31 317 48 25 93, e-mail: ingridm.bakker{at}wur.nl

Received September 18, 2008 , accepted December 29, 2008

Background: The primary care evaluation of mental disorders (PRIME-MD) can be seen as characteristic for successive refinements of criteria and structured interview techniques for diagnosing psychiatric disorders in primary care. It is one of the most widely used instruments, but there is no evidence to support its test–retest reliability. Methods: With 1-week intervals between interviews, a test–retest study of the PRIME-MD was conducted in a general practice population of 100 distressed patients (20- to 60-years old) who were on sick leave. Results: Almost everyone (89%) received one or more diagnoses at both measurements, and there was fair total agreement ({kappa} = 0.27). The best agreement was found for more severe threshold disorders [major depressive disorder ({kappa} = 0.58), dysthymia ({kappa} = 0.57), and generalized anxiety disorder ({kappa} = 0.59)], while we found indefinite results for the sub-threshold disorders [anxiety disorder not otherwise specified (NOS) ({kappa} =.30), minor depressive disorder ({kappa} = –0.03), and somatoform disorder NOS ({kappa} = 0.11)]. Conclusion: The PRIME-MD is one of the few instruments in primary care that actually diagnoses specific mental disorders according to the DSM criteria. However, there was a failure to adequately classify sub-threshold disorders. Mental disorders, as seen in primary care, encompass important specific symptoms and clinical syndromes that vary in duration and severity over time, but they also encompass an admixture of somatic and psychological symptoms that do not match current diagnostic systems. This most likely resulted in methodological uncertainty about the level of agreement. Diagnostic criteria in psychiatry need to be operationalized for use in primary care and require further evaluation.

Keywords: diagnostics, general practice, mental health problems, primary care, test–retest


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