Preliminary communication A clinical predictive score for mood disorder risk in low-income primary care settings P.A. Vöhringer a,c,d,e,n , M.I. Jimenez a , M.A. Igor a , G.A. Fore ́ s f , M.O. Correa g , M.C. Sullivan c , N.S. Holtzman c , E.A. Whitham c , S.A. Barroilhet b,c , K. Alvear j , T. Logvinenko i , D.M. Kent h , S.N. Ghaemi c,d a Hospital Clínico Universidad de Chile, Unidad de Trastornos del Ánimo, Clínica Psiquiátrica Universitaria, Facultad Medicina, Universidad de Chile, Santiago, Chile b Escuela de Psicología, Universidad de los Andes, Santiago, Chile c Mood Disorders Program, Tufts Medical Center, Boston, MA, United States d Tufts University School of Medicine, Boston, MA, United States e Graduate Program, Clinical and Translational Science Institute (CTSI), Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA, United States f Departamento Neurología, Universidad Mayor, Santiago, Chile g Departamento Psiquiatría, Facultad Medicina, Universidad de los Andes, Santiago, Chile h Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA i Biostatistics Research Center at the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States j Universidad Diego Portales, Santiago, Chile article info Article history: Received 15 June 2013 Accepted 26 June 2013 Available online 31 July 2013 Keywords: Mood disorders Diagnosis Screening Primary health care Bipolar disorder Depression abstract Background: Despite availability of validated screening tests for mood disorders, busy general practi- tioners (GPs) often lack the time to use them routinely. This study aimed to develop a simplified clinical predictive score to help screen for presence of current mood disorder in low-income primary care settings. Methods: In a cross-sectional study, 197 patients seen at 10 primary care centers in Santiago, Chile completed self-administered screening tools for mood disorders: the Patient Health questionnaire (PHQ-9) and the Mood Disorder Questionnaire (MDQ). To determine participants’ current-point mood disorder status, trained clinicians applied a gold-standard diagnostic interview (SCID-I). A simplified clinical predictive model (CM) was developed based on clinical features and selected questions from the screening tools. Using CM, a clinical predictive score (PS) was developed. Full PHQ-9 and GP assessment were compared with PS. Results: Using multivariate logistic regression, clinical and demographic variables predictive of current mood disorder were identified for a simplified 8-point predictive score (PS). PS had better discrimination than GP assessment (auROC-statistic ¼0.80 [95% CI 0.72, 0.85] vs. 0.58 [95% CI 0.52, 0.62] p-value o0.0001), but not as good as the full PHQ-9 (0.89 [95% CI 0.85, 0.93], p-value ¼0.03). Compared with GP assessment, PS increased sensitivity by 50% at a fixed specificity of 90%. Administered in a typical primary care clinical population, it correctly predicted almost 80% of cases. Limitations: Further research must verify external validity of the PS. Conclusion: An easily administered clinical predictive score determined, with reasonable accuracy, the current risk of mood disorders in low-income primary care settings. & 2013 Elsevier B.V. All rights reserved. 1. Introduction In Chile, diagnosis and treatment of mood disorders in primary care settings (PCS) is based on non-standardized clinical assessment by general practitioners (GP), despite the fact that Santiago, its capital, has the largest proportion of depressed people abroad (Simon et al., 1999). GPs are frequently overburdened, with numer- ous patients to treat daily, creating an environment in which a complete mental health evaluation is unlikely to be administered. Most GP spend only 5–10 min with each patient, making mood disorder assessment even more difficult. While screening tests for mood disorders in primary care settings have proven useful, applying and interpreting the results Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jad Journal of Affective Disorders 0165-0327/$ - see front matter & 2013 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.jad.2013.06.056 n Corresponding author at: Tufts Medical Center, Mood Disorders Program, 800 Washington St. #1007, Boston, MA 02111, United States. Tel.: +1 617 636 5735; fax: +1 617 636 7795. E-mail address: PVohringer@tuftsmedicalcenter.org (P.A. Vöhringer). Journal of Affective Disorders 151 (2013) 1125–1131