NEW YORK -- A simple, one-page patient questionnaire that provides an extraordinarily fast diagnosis of mental illness can help keep internists and family physicians from missing the first important signals that their patient may need help, researchers say.
Testing of the questionnaire, conducted at four sites around the country, found that 26 percent of the 1,000 study participants had a diagnosable mental illness and an additional 13 percent had sufficient symptoms to consider treatment.
Dr. Robert Spitzer of the New York State Psychiatric Institute at Columbia University said the eight minutes it takes to administer the form enabled doctors to pick up 50 percent to 70 percent more people than they would during a standard physical examination.
The program, called PRIME-MD, turned out to be accurate 88 percent of the time, researchers said.
The reason mental illness is normally so underreported is that patients often complain of physical symptoms and are reluctant to discuss personal and emotional problems with doctors. In turn, doctors rarely discuss emotional issues with patients.
"Many physicians are poorly trained in recognizing minor forms of mental illness," said Dr. Spitzer.
The findings were presented yesterday at a medical symposium in New York sponsored by the Journal of the American Medical Association. The study was reported in a special mental illness issue of the journal this week.
Development and testing of the diagnostic test was supported by a grant from Pfizer Inc., a pharmaceutical company that manufactures Zoloft, one of the latest anti-depressants on the market. The company has held almost 200 symposiums over the past 18 months, training more than 8,000 doctors.
Dr. Spitzer and other psychiatrists knew such a simple diagnostic tool was necessary because more than 60 percent of people with mental illnesses are treated by primary-care doctors, and not by psychiatrists.
In the study, only 14 percent of patients identified with a mental disorder were referred to a mental health professional, said Dr. Kurt Kroenke, assistant professor of medicine at the Uniformed Services University of the Health Sciences in Bethesda.
Dr. Kroenke stressed that a prescription doesn't always go hand-in-hand with a diagnosis of mental illness. Many times, the condition is mild and requires watching.
Mental illness is a major health problem. Depression alone affects 14 million adults in the United States.
Another reliable diagnostic test reported on during yesterday's symposium was developed by researchers at the Johns Hopkins Medical Institutions. Identifying people at risk for suicide could decrease the high suicide rate -- 15 percent -- among people with severe forms of mental illness, according to Dr. Lisa Cooper-Patrick, an internist who tested the four-question survey.
Dr. Cooper-Patrick and her colleagues interviewed 6,000 people and found that 154, or 2.6 percent of the group, said they had suicidal thoughts in the last year. People most at risk for suicidal thinking were young, white and single or divorced, Dr. Cooper-Patrick said.
People who were depressed were 10 times more likely to have such dire thoughts. By contrast, people who reported feelings of hopelessness were 25 times more likely to think deadly thoughts.
"The survey can help doctors assess patients' needs for further treatment," she told her colleagues at the meeting. "The best strategy for suicide prevention is identification of mental disorders."
The questions should be asked even when patients don't exhibit obvious signs of clinical depression, the doctors said.
"If physicians ask only people who meet the criteria for major depression whether they are having suicidal thoughts, they are likely to miss two-thirds of their patients who are thinking about suicide," said Dr. Cooper-Patrick.
The Hopkins doctors suggested that physicians ask their own versions of the following questions, which could be asked directly or on a written questionnaire.
* Have you ever had a period of two weeks or more when you had trouble falling asleep, staying asleep, waking up too early or sleeping too much?
* Have you ever had two weeks or more during which you felt sad, blue, depressed or when you lost interest and pleasure in things that you usually cared about or enjoyed?
* Has there been a period of two weeks or more when you felt worthless, sinful or guilty?
* Has there ever been a period of time when you felt that life was hopeless?
If a patient answers "yes" to any of these questions, the doctor should consider referring that person to a mental health specialist for a consultation, the doctors said.