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Results From the PRIME-MD 1000 Study

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

JAMA. 1995;274(19):1511-1517.

Abstract
Objective.
—To determine if different mental disorders commonly seen in primary care are uniquely associated with distinctive patterns of impairment in the components of health-related quality of life (HRQL) and how this compares with the impairment seen in common medical disorders.

Design.
—Survey.

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 using PRIME-MD (Primary Care Evaluation of Mental Disorders) to make diagnoses of mood, anxiety, alcohol, somatoform, and eating disorders.

Main Outcome Measures.
—The six scales of the Short-Form General Health Survey and self-reported disability days, adjusting for demographic variables as well as psychiatric and medical comorbidity.

Results.
—Mood, anxiety, somatoform, and eating disorders were associated with substantial impairment in HRQL. Impairment was also present in patients who only had subthreshold mental disorder diagnoses, such as minor depression and anxiety disorder not otherwise specified. Mental disorders, particularly mood disorders, accounted for considerably more of the impairment on all domains of HRQL than did common medical disorders. Finally, we found marked differences in the pattern of impairment among different groups of mental disorders just as others have reported unique patterns associated with different medical disorders. Whereas mood disorders had a pervasive effect on all domains of HRQL, anxiety, somatoform, and eating disorders affected only selected domains.

Conclusions.
—Mental disorders commonly seen in primary care are not only associated with more impairment in HRQL than common medical disorders, but also have distinct patterns of impairment. Primary care directed at improving HRQL needs to focus on the recognition and treatment of common mental disorders. Outcomes studies of mental disorders in both primary care and psychiatric settings should include multidimensional measures of HRQL.

(JAMA. 1995;274:1511-1517)

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

Footnotes
Corresponding author: Robert L. Spitzer, MD, Biometrics Research Department, Unit 74, New York State Psychiatric Institute, 722 W 168 St, New York, NY 10032.

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