This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

The PRIME-MD 1000 Study

Robert L. Spitzer, MD; Janet B. W. Williams, DSW; Kurt Kroenke, MD; Mark Linzer, MD; Frank Verloin deGruy III, MD; Steven R. Hahn, MD; David Brody, MD; Jeffrey G. Johnson, PhD

JAMA. 1994;272(22):1749-1756.

Abstract
Objective.
—To assess the validity and utility of PRIME-MD (Primary Care Evaluation of Mental Disorders), a new rapid procedure for diagnosing mental disorders by primary care physicians.

Design.
—Survey; criterion standard.

Setting.
—Four primary care clinics.

Subjects.
—A total of 1000 adult patients (369 selected by convenience and 631 selected by site-specific methods to avoid sampling bias) assessed by 31 primary care physicians.

Main Outcome Measures.
—PRIME-MD diagnoses, independent diagnoses made by mental health professionals, functional status measures (Short-Form General Health Survey), disability days, health care utilization, and treatment/ referral decisions.

Results.
—Twenty-six percent of the patients had a PRIME-MD diagnosis that met full criteria for a specific disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. The average time required of the primary care physician to complete the PRIME-MD evaluation was 8.4 minutes. There was good agreement between PRIME-MD diagnoses and those of independent mental health professionals (for the diagnosis of any PRIME-MD disorder, =0.71; overall accuracy rate=88%). Patients with PRIME-MD diagnoses had lower functioning, more disability days, and higher rates of health care utilization than did patients without PRIME-MD diagnoses (for all measures, P<.005). Nearly half (48%) of 287 patients with a PRIME-MD diagnosis who were somewhat or fairly well-known to their physicians had not been recognized to have that diagnosis before the PRIME-MD evaluation. A new treatment or referral was initiated for 62% of the 125 patients with a PRIME-MD diagnosis who were not already being treated.

Conclusion.
—PRIME-MD appears to be a useful tool for identifying mental disorders in primary care practice and research.

(JAMA. 1994;272:1749-1756)

Author Affiliations
From the Biometrics Research Department, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY (Drs Spitzer, Williams, and Johnson); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (Dr Kroenke); Department of Medicine, New England Medical Center, Boston, Mass (Dr Linzer); Department of Family Practice in Community Medicine, University of South Alabama College of Medicine, Mobile (Dr deGruy); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (Dr Hahn); and Department of Medicine, Mercy Catholic Medical Center, Darby, Pa (Dr Brody).

Footnotes
Reprint requests to Biometrics Research Department, Unit 74, New York State Psychiatric Institute, 722 W 168 St, New York, NY 10032 (Dr Spitzer).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Apathy and Functioning in First-Episode Psychosis
Faerden et al.
Psychiatr. Serv. 2009;60:1495-1503.
ABSTRACT | FULL TEXT  

A Culturally Relevant and Responsive Approach to Screening for Perinatal Depression
Price and Handrick
Research on Social Work Practice 2009;19:705-714.
ABSTRACT  

Posttraumatic Stress Disorder and Health-Related Quality of Life in Patients With Coronary Heart Disease: Findings From the Heart and Soul Study
Cohen et al.
Arch Gen Psychiatry 2009;66:1214-1220.
ABSTRACT | FULL TEXT  

Association of Resident Fatigue and Distress With Perceived Medical Errors
West et al.
JAMA 2009;302:1294-1300.
ABSTRACT | FULL TEXT  

Efficacy of Treatment for Somatoform Disorders: A Review of Randomized Controlled Trials
Kroenke
Focus 2009;7:414-423.
ABSTRACT | FULL TEXT  

The Association of Cognitive and Somatic Depressive Symptoms With Depression Recognition and Outcomes After Myocardial Infarction
Smolderen et al.
Circ Cardiovasc Qual Outcomes 2009;2:328-337.
ABSTRACT | FULL TEXT  

Psychiatric Treatment Received by Primary Care Patients With Panic Disorder With and Without Agoraphobia
Marcks et al.
Psychiatr. Serv. 2009;60:823-830.
ABSTRACT | FULL TEXT  

Test-retest reliability of the PRIME-MD: limitations in diagnosing mental disorders in primary care
Bakker et al.
Eur J Public Health 2009;19:303-307.
ABSTRACT | FULL TEXT  

Optimized Antidepressant Therapy and Pain Self-management in Primary Care Patients With Depression and Musculoskeletal Pain: A Randomized Controlled Trial
Kroenke et al.
JAMA 2009;301:2099-2110.
ABSTRACT | FULL TEXT  

Neurocognitive Dysfunction in Bipolar and Schizophrenia Spectrum Disorders Depends on History of Psychosis Rather Than Diagnostic Group
Simonsen et al.
Schizophr Bull 2009;0:sbp034v1-sbp034.
ABSTRACT | FULL TEXT  

Improving Exercise Tolerance and Quality of Life in Patients With Chronic Obstructive Pulmonary Disease
Belfer and Reardon
JAOA: Journal of the American Osteopathic Association 2009;109:268-278.
ABSTRACT | FULL TEXT  

Detecting Somatoform Disorders in Primary Care With the PHQ-15
van Ravesteijn et al.
Ann Fam Med 2009;7:232-238.
ABSTRACT | FULL TEXT  

Asking For Help is Helpful: Validation of a Brief Lifestyle and Mood Assessment Tool in Primary Health Care
Goodyear-Smith et al.
Ann Fam Med 2009;7:239-244.
ABSTRACT | FULL TEXT  

Daytime Sleepiness and Functional Outcomes in Older Adults With Diabetes
Chasens et al.
The Diabetes Educator 2009;35:455-464.
ABSTRACT | FULL TEXT  

Cognitive Behavior Therapy for Generalized Anxiety Disorder Among Older Adults in Primary Care: A Randomized Clinical Trial
Stanley et al.
JAMA 2009;301:1460-1467.
ABSTRACT | FULL TEXT  

Assessment of Anxiety and Depression in Primary Care: Value of a Four-Item Questionnaire
Rickels et al.
JAOA: Journal of the American Osteopathic Association 2009;109:216-219.
ABSTRACT | FULL TEXT  

Stress and Burnout Among Surgeons: Understanding and Managing the Syndrome and Avoiding the Adverse Consequences
Balch et al.
Arch Surg 2009;144:371-376.
FULL TEXT  

Assessment of Anxiety in Older Home Care Recipients
Diefenbach et al.
The Gerontologist 2009;49:141-153.
ABSTRACT | FULL TEXT  

The Role of Mood Disorders in Exercise-Induced Cardiovascular Reactivity
Pelletier et al.
Psychosom. Med. 2009;71:301-307.
ABSTRACT | FULL TEXT  

Collaborative Care for Chronic Pain in Primary Care: A Cluster Randomized Trial
Dobscha et al.
JAMA 2009;301:1242-1252.
ABSTRACT | FULL TEXT  

Mental Health of Children of Low-Income Depressed Mothers: Influences of Parenting, Family Environment, and Raters
Riley et al.
Psychiatr. Serv. 2009;60:329-336.
ABSTRACT | FULL TEXT  

ApoE alleles, depression and positive affect in multiple sclerosis
Julian et al.
Mult Scler 2009;15:311-315.
ABSTRACT  

Outcome of depression in later life in primary care: longitudinal cohort study with three years' follow-up
Licht-Strunk et al.
BMJ 2009;338:a3079-a3079.
ABSTRACT | FULL TEXT  

Depression and heart disease: What do we know, and where are we headed?
POZUELO et al.
Cleveland Clinic Journal of Medicine 2009;76:59-70.
ABSTRACT | FULL TEXT  

Burnout and patient care in junior doctors in Mexico City
Toral-Villanueva et al.
Occup Med (Lond) 2009;59:8-13.
ABSTRACT | FULL TEXT  

Comparison of Self-report Measures for Identifying Late-life Generalized Anxiety in Primary Care
Webb et al.
J Geriatr Psychiatry Neurol 2008;21:223-231.
ABSTRACT  

Behavioral Activation for Latinos With Depression
Kanter et al.
Clinical Case Studies 2008;7:491-506.
ABSTRACT  

Randomized Controlled Trial of Problem-Solving Therapy for Minor Depression in Home Care
Gellis et al.
Research on Social Work Practice 2008;18:596-606.
ABSTRACT  

The association between anxiety and alcohol versus cannabis abuse disorders among adolescents in primary care settings
Low et al.
Fam Pract 2008;25:321-327.
ABSTRACT | FULL TEXT  

Association of Depression and Anxiety Alone and in Combination With Chronic Musculoskeletal Pain in Primary Care Patients
Bair et al.
Psychosom. Med. 2008;70:890-897.
ABSTRACT | FULL TEXT  

Anxiety and Depression in COPD: Current Understanding, Unanswered Questions, and Research Needs
Maurer et al.
Chest 2008;134:43S-56S.
ABSTRACT | FULL TEXT  

Burnout and Suicidal Ideation among U.S. Medical Students
Dyrbye et al.
ANN INTERN MED 2008;149:334-341.
ABSTRACT | FULL TEXT  

Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment
Volgsten et al.
Hum Reprod 2008;23:2056-2063.
ABSTRACT | FULL TEXT  

Alcohol Use and Alcohol-Related Problems Before and After Military Combat Deployment
Jacobson et al.
JAMA 2008;300:663-675.
ABSTRACT | FULL TEXT  

Prevalence, Impact, and Prognosis of Multisomatoform Disorder in Primary Care: A 5-Year Follow-up Study
Jackson and Kroenke
Psychosom. Med. 2008;70:430-434.
ABSTRACT | FULL TEXT  

Prevalence and characteristics of allodynia in headache sufferers: A population study
Bigal et al.
Neurology 2008;70:1525-1533.
ABSTRACT | FULL TEXT  

Depression in Patients With Heart Failure: Prevalence, Pathophysiological Mechanisms, and Treatment
Thomas et al.
Crit Care Nurse 2008;28:40-55.
FULL TEXT  

Improving Access to Mental Health Services for New York State Prison Inmates
Gebbie et al.
J Correct Health Care 2008;14:122-135.
ABSTRACT  

Does Stigma Keep Poor Young Immigrant and U.S.-Born Black and Latina Women From Seeking Mental Health Care?
Nadeem et al.
Psychiatr. Serv. 2007;58:1547-1554.
ABSTRACT | FULL TEXT  

When Epidemiology Meets the Internet: Web-based Surveys in the Millennium Cohort Study
Smith et al.
Am J Epidemiol 2007;166:1345-1354.
ABSTRACT | FULL TEXT  

Efficacy of Treatment for Somatoform Disorders: A Review of Randomized Controlled Trials
Kroenke
Psychosom. Med. 2007;69:881-888.
ABSTRACT | FULL TEXT  

What is the Evidence for the Efficacy of Treatments for Somatoform Disorders? A Critical Review of Previous Intervention Studies
Sumathipala
Psychosom. Med. 2007;69:889-900.
ABSTRACT | FULL TEXT  

Race, Ethnicity, and Medical Student Well-being in the United States
Dyrbye et al.
Arch Intern Med 2007;167:2103-2109.
ABSTRACT | FULL TEXT  

Outcomes of a quality improvement project integrating mental health into primary care
Watts et al.
Qual Saf Health Care 2007;16:378-381.
ABSTRACT | FULL TEXT  

Head or neck injury increases the risk of chronic daily headache: A population-based study
Couch et al.
Neurology 2007;69:1169-1177.
ABSTRACT | FULL TEXT  

Effectiveness of a Time-Limited Cognitive Behavior Therapy Type Intervention Among Primary Care Patients With Medically Unexplained Symptoms
Escobar et al.
Ann Fam Med 2007;5:328-335.
ABSTRACT | FULL TEXT  

Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Alcohol Abuse and Dependence in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions
Hasin et al.
Arch Gen Psychiatry 2007;64:830-842.
ABSTRACT | FULL TEXT  

Behavioral Medecine Review: The Lifestyle Factor
Terre
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2007;1:181-184.
ABSTRACT  

Suffering With Advanced Cancer
Wilson et al.
JCO 2007;25:1691-1697.
ABSTRACT | FULL TEXT  

Depression and Cost-Related Medication Nonadherence in Medicare Beneficiaries
Bambauer et al.
Arch Gen Psychiatry 2007;64:602-608.
ABSTRACT | FULL TEXT  

In-Home Cognitive Behavior Therapy for a Depressed Mother in a Home Visitation Program
Ammerman et al.
Clinical Case Studies 2007;6:161-180.
ABSTRACT  

Psychiatric disorders in inpatients on a neurology ward: estimate of prevalence and usefulness of screening questionnaires
Jefferies et al.
J. Neurol. Neurosurg. Psychiatry 2007;78:414-416.
ABSTRACT | FULL TEXT  

Outcome and Impact of Mental Disorders in Primary Care at 5 years
Jackson et al.
Psychosom. Med. 2007;69:270-276.
ABSTRACT | FULL TEXT  

Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and Detection
Kroenke et al.
ANN INTERN MED 2007;146:317-325.
ABSTRACT | FULL TEXT  

Brief Intervention for Medical Inpatients with Unhealthy Alcohol Use: A Randomized, Controlled Trial
Saitz et al.
ANN INTERN MED 2007;146:167-176.
ABSTRACT | FULL TEXT  

A Practical Screening Tool for Anxiety and Depression in Patients With Chronic Breathing Disorders
Kunik et al.
Psychosomatics 2007;48:16-21.
ABSTRACT | FULL TEXT  

Integrating Depression Care With Diabetes Care in Real-World Settings: Lessons From the Robert Wood Johnson Foundation Diabetes Initiative
Anderson et al.
Diabetes Spectr. 2007;20:10-16.
ABSTRACT | FULL TEXT  

Black Women's Health: The Effect of Perceived Racism and Intimate Partner Violence
Waltermaurer et al.
Violence Against Women 2006;12:1214-1222.
ABSTRACT  

Limitations of the Patient Health Questionnaire in Identifying Anxiety and Depression in Community Mental Health: Many Cases are Undetected
Eack et al.
Research on Social Work Practice 2006;16:625-631.
ABSTRACT  

A Multicenter Study of Burnout, Depression, and Quality of Life in Minority and Nonminority US Medical Students
Dyrbye et al.
Mayo Clin Proc. 2006;81:1435-1442.
ABSTRACT | FULL TEXT  

Depression in Heart Failure: A Meta-Analytic Review of Prevalence, Intervention Effects, and Associations With Clinical Outcomes
Rutledge et al.
J Am Coll Cardiol 2006;48:1527-1537.
ABSTRACT | FULL TEXT  

Treatment for Cigarette Smoking Among Depressed Mental Health Outpatients: A Randomized Clinical Trial
Hall et al.
AJPH 2006;96:1808-1814.
ABSTRACT | FULL TEXT  

What is worse for asthma control and quality of life: depressive disorders, anxiety disorders, or both?
Lavoie et al.
Chest 2006;130:1039-1047.
ABSTRACT | FULL TEXT  

Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study.
West et al.
JAMA 2006;296:1071-1078.
ABSTRACT | FULL TEXT  

Job Performance Deficits Due to Depression
Adler et al.
Am. J. Psychiatry 2006;163:1569-1576.
ABSTRACT | FULL TEXT  

Improving Recognition of Adolescent Depression in Primary Care
Zuckerbrot and Jensen
Arch Pediatr Adolesc Med 2006;160:694-704.
ABSTRACT | FULL TEXT  

Adding a question that asks whether help is wanted improves sensitivity of a depression screening tool.
Lowe
Evid. Based Ment. Health 2006;9:39-39.
FULL TEXT  

Military deployment to the Gulf War as a risk factor for psychiatric illness among US troops
FIEDLER et al.
Br. J. Psychiatry 2006;188:453-459.
ABSTRACT | FULL TEXT  

Should we screen for depression?
Gilbody et al.
BMJ 2006;332:1027-1030.
FULL TEXT  

One size fits all?
Anderson
CMAJ 2006;174:1132-1133.
FULL TEXT  

Benchmarks for designing two-stage studies using modified mini-mental state examinations: experience from the Women's Health Initiative Memory Study
Espeland et al.
Clin Trials 2006;3:99-106.
ABSTRACT  

Associations of hormones and menopausal status with depressed mood in women with no history of depression.
Freeman et al.
Arch Gen Psychiatry 2006;63:375-382.
ABSTRACT | FULL TEXT  

Perspectives on Depression, Mild Cognitive Impairment, and Cognitive Decline
Steffens et al.
Arch Gen Psychiatry 2006;63:130-138.
ABSTRACT | FULL TEXT  

Increased Serum Levels of 8-Hydroxy-2'-Deoxyguanosine in Clinical Depression
Forlenza and Miller
Psychosom. Med. 2006;68:1-7.
ABSTRACT | FULL TEXT  

Depression and Prehospital Delay in the Context of Myocardial Infarction
Bunde and Martin
Psychosom. Med. 2006;68:51-57.
ABSTRACT | FULL TEXT  

The Effects of Work-Hour Limitations on Resident Well-being, Patient Care, and Education in an Internal Medicine Residency Program
Goitein et al.
Arch Intern Med 2005;165:2601-2606.
ABSTRACT | FULL TEXT  

A Randomized Trial to Improve the Quality of Treatment for Panic and Generalized Anxiety Disorders in Primary Care
Rollman et al.
Arch Gen Psychiatry 2005;62:1332-1341.
ABSTRACT | FULL TEXT  

Suicidal Ideation and Risk Levels Among Primary Care Patients With Uncomplicated Depression
Schulberg et al.
Ann Fam Med 2005;3:523-528.
ABSTRACT | FULL TEXT  

Clinical Depression and Regulation of the Inflammatory Response During Acute Stress
Miller et al.
Psychosom. Med. 2005;67:679-687.
ABSTRACT | FULL TEXT  

Perceived Unmet Need for Mental Health Treatment and Barriers to Care Among Patients With Panic Disorder
Craske et al.
Psychiatr. Serv. 2005;56:988-994.
ABSTRACT | FULL TEXT  

Are patients with COPD psychologically distressed?
Wagena et al.
Eur Respir J 2005;26:242-248.
ABSTRACT | FULL TEXT  

Cost-effectiveness of Evidence-Based Pharmacotherapy or Cognitive Behavior Therapy Compared With Community Referral for Major Depression in Predominantly Low-Income Minority Women
Revicki et al.
Arch Gen Psychiatry 2005;62:868-875.
ABSTRACT | FULL TEXT  

Somatization Increases Medical Utilization and Costs Independent of Psychiatric and Medical Comorbidity
Barsky et al.
Arch Gen Psychiatry 2005;62:903-910.
ABSTRACT | FULL TEXT  

A brief case-finding questionnaire for common mental disorders: the CMDQ
Christensen et al.
Fam Pract 2005;22:448-457.
ABSTRACT | FULL TEXT  

Screening for common mental disorders: who will benefit? Results from a randomised clinical trial
Christensen et al.
Fam Pract 2005;22:428-434.
ABSTRACT | FULL TEXT  

Specific Effects of Depression, Panic, and Somatic Symptoms on Illness Behavior
Rief et al.
Psychosom. Med. 2005;67:596-601.
ABSTRACT | FULL TEXT  

Depression Among Latina Immigrant Mothers Separated From Their Children
Miranda et al.
Psychiatr. Serv. 2005;56:717-720.
ABSTRACT | FULL TEXT  

Identifying palliative care patients with symptoms of depression: an algorithm
Robinson and Crawford
Palliat Med 2005;19:278-287.
ABSTRACT  

'Goodbye and good luck': the mental health needs and treatment experiences of British ex-service personnel
IVERSEN et al.
Br. J. Psychiatry 2005;186:480-486.
ABSTRACT | FULL TEXT  

Depression and anxiety in epilepsy
Jackson and Turkington
J. Neurol. Neurosurg. Psychiatry 2005;76:i45-i47.
FULL TEXT