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The role of comorbidity in the detection of psychiatric disorders with checklists for mental and physical symptoms in primary care

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Abstract

Objective

To examine the contribution of a mental and physical symptom count to the detection of single or comorbid anxiety, depressive and somatoform disorders.

Method

In primary care 1,046 consulting patients completed the Hospital Anxiety and Depression Scale (HADS) and the Physical Symptom Checklist (PSC-51). In a stratified sample of 473 patients DSM-IV psychiatric disorders were assessed using the WHO-SCAN interview. The diagnostic value of the HADS total score and the PSC-51 symptom count was examined with ROC-analyses.

Results

The discriminative power of PSC-51 and HADS was highest for patients with both a somatoform disorder and an anxiety or depressive disorder, with an AUC of 0.86 (95% CI: 0.81–0.91) and 0.91 (95% CI: 0.87–0.94) respectively. Using both symptom counts together did not increase the diagnostic value for the detection of the psychiatric disorders.

Conclusion

Both symptom counts preferentially detected patients with comorbid disorders. When interpreting diagnostic values of screening questionnaires one should keep in mind that the validity of these values can be dependent of the presence of comorbid disorders.

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Acknowledgments

The Netherlands Organization for Health Research and Development (ZON-MW) funded this study. We thank our data-assistants Lucia Hoogenboom and Geesje Driebergen and the interviewers Jacqueline Piederiet and Marjan Brouwer for their commitment.

Author information

Authors and Affiliations

  1. Dept. of Public Health and Primary Care, Leiden University Medical Center, P. O. Box 9600, 2300 RC, Leiden, The Netherlands

    Margot W. M. de Waal PhD, Ingrid A. Arnold MD, PhD, Just A. H. Eekhof MD, PhD & Willem J. J. Assendelft MD, PhD

  2. Dept. of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands

    Philip Spinhoven PhD & Albert M. van Hemert MD, PhD

  3. Section of Clinical, Health and Neuropsychology, University of Leiden, Leiden, The Netherlands

    Philip Spinhoven PhD

  4. Parnassia Bavo Psychiatric Institute, The Hague, The Netherlands

    Albert M. van Hemert MD, PhD

Authors
  1. Margot W. M. de Waal PhD
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  2. Ingrid A. Arnold MD, PhD
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  3. Philip Spinhoven PhD
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  4. Just A. H. Eekhof MD, PhD
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  5. Willem J. J. Assendelft MD, PhD
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  6. Albert M. van Hemert MD, PhD
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Corresponding author

Correspondence to Margot W. M. de Waal PhD.

Appendix: list of symptoms from the physical symptom checklist

Appendix: list of symptoms from the physical symptom checklist

  1. 1.

    Feeling tired or having low energy

  2. 2.

    Easily fatigued without exertion

  3. 3.

    Shortness of breath without exertion

  4. 4.

    Palpitations

  5. 5.

    Pain or pressure on the chest

  6. 6.

    Dizziness or light headedness

  7. 7.

    Fainting or loss of consciousness

  8. 8.

    Sleeplessness

  9. 9.

    Sleeping a lot

  10. 10.

    Forgetfulness

  11. 11.

    Tingling sensations

  12. 12.

    Trembling

  13. 13.

    Muscle weakness or paralysis

  14. 14.

    Muscle tension

  15. 15.

    Muscle aches or soreness

  16. 16.

    Trouble walking

  17. 17.

    Loss of voice

  18. 18.

    Deafness

  19. 19.

    Double vision or blurred vision

  20. 20.

    Blindness

  21. 21.

    Seizure or convulsion (epileptic)

  22. 22.

    Nausea

  23. 23.

    Vomiting

  24. 24.

    Dry mouth

  25. 25.

    Trouble swallowing

  26. 26.

    Choking a lot

  27. 27.

    Intolerance of specific foods

  28. 28.

    Loss of appetite

  29. 29.

    Weight loss (last month)

  30. 30.

    Heartburn

  31. 31.

    Abdominal pain

  32. 32.

    Abdominal distress (gassy)

  33. 33.

    Diarrhoea

  34. 34.

    Constipation

  35. 35.

    Flatulence

  36. 36.

    Sweating

  37. 37.

    Flushes (hot flashes)

  38. 38.

    Intolerance to heat

  39. 39.

    Chills

  40. 40.

    Intolerance to cold

  41. 41.

    Headache

  42. 42.

    Joint pain

  43. 43.

    Pain in extremities

  44. 44.

    Back pain

  45. 45.

    Other pain

  46. 46.

    Frequent urination

  47. 47.

    Difficulty urinating

  48. 48.

    Pain during urination

  49. 49.

    Burning sensation in sexual organs or rectum

  50. 50.

    Pain during intercourse

  51. 51.

    Sexual indifference

When applicable:

  1. 52.

    Impotence

  2. 53.

    Irregular menstrual periods

  3. 54.

    Painful menstruation

  4. 55.

    Excessive menstrual bleeding

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de Waal, M.W.M., Arnold, I.A., Spinhoven, P. et al. The role of comorbidity in the detection of psychiatric disorders with checklists for mental and physical symptoms in primary care. Soc Psychiat Epidemiol 44, 78–85 (2009). https://doi.org/10.1007/s00127-008-0410-5

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  • DOI: https://doi.org/10.1007/s00127-008-0410-5

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