A computer-administered telephone interview to identify mental disorders

Administering a diagnostic test for detecting mental disorders using interactive voice response (IVR) technology appears to be effective. IVR technology involves a patient dialing an 800 telephone number and using a touch-tone telephone to answer questions. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was administered over the telephone by a physician and by IVR to 200 patients. A subset of patients were also interviewed in person. About 60% of the patients were diagnosed with a psychiatric disorder by both techniques. However, the prevalence of alcohol abuse was twice as high when using IVR.
Context. -- Common mental disorders are often not identified in primary care settings. Objective. -- To evaluate the validity and clinical utility of a telephone-assisted computer-administered version of Primary Care Evaluation of Mental Disorders (PRIME-MD), a brief questionnaire and interview instrument designed to identify psychiatric disorders in primary care patients. Design. -- Comparison of diagnoses obtained by computer over the telephone using interactive voice response (IVR) technology vs those obtained by a trained clinician over the telephone using the Structured Clinical Interview for DSM-IV [Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition] Diagnosis (SCID). A subsample also received the clinician-administered version of PRIME-MD. Patients. -- Outpatients (N=200) from 4 primary care clinics, an eating disorders clinic, an alcohol treatment facility, psychiatric outpatients, and community controls. Setting. -- Interviews conducted by telephone, except for face-to-face administration of PRIME-MD, which was conducted at either the primary care clinic or a research clinic. Measurements and Main Results. -- Prevalence rates for any psychiatric disorder were similar between diagnoses made by the computer and those made by a mental health professional using the SCID (60.0% vs 58.5%). Prevalence rates for individual diagnoses were generally similar across versions. However, primary care patients reported twice as much alcohol abuse on the computer (15.0%) as on either the SCID (7.5%) or the clinician-administered PRIME-MD (7.5%). Using the SCID as the criterion, both the computer- and clinician-administered versions of PRIME-MD demonstrated high and roughly equivalent levels of sensitivity and specificity. Overall agreement ([Kappa]) for any diagnosis was 0.67 for the computer-administered PRIME-MD and 0.70 for the clinician-administered PRIME-MD. Conclusions. -- the computer-administered PRIME-MD appears to be a valid instrument for assessing psychopathology in primary care patients. Interactive voice response technology allows for increased availability, and provides primary care physicians with information that will increase the quality of patient care without additional physician time and at minimal expense.