Psychiatry and primary careAnxiety and mood disorders in otorhinolaryngology outpatients presenting with dizziness: validation of the self-administered PRIME-MD Patient Health Questionnaire and epidemiology
Introduction
Dizziness is a common complaint which is accompanied by significant impairment of quality of life [1], [2] and by significant emotional distress [3]. Recent reviews [4], [5] indicated that in 2–26% of the patients presenting with a chief complaint of dizziness, psychiatric disorders played a causative or contributory role.
Recognition of these disorders is essential in the care for dizziness patients but to our knowledge, no self-administered instrument has been validated for otorhinolaryngology patients to assess categorical psychiatric disorders (i.e., according to the internationally accepted diagnostic criteria). Often used and self-administered questionnaires, such as the Beck Depression Inventory [6] and the Hospital Anxiety and Depression Scale [7] generate a dimensional measure of the intensity of depressive and anxious states and are therefore insufficient to generate categorical psychiatric diagnoses. The PRIME-MD Patient Health Questionnaire (PRIME-MD PHQ) is the first self-administered instrument to assess categorical psychiatric disorders according to the diagnostic criteria of DSM-IV [8]. It was originally validated in primary care patients [9] and it has recently been validated in obstetrics-gynecology [10], in gastroenterology [11], and in general hospital patients [12].
Several studies [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23] assessed the prevalence of categorical psychiatric disorders in patients with a chief complaint of dizziness. Prevalence varied substantially between 6–100% for any psychiatric disorder, 9.3–62% for depressive disorders, 1.8–38% for major depressive disorder, 16.6–94% for anxiety disorders and 3–76% for panic disorder. In outpatients attending a general hospital, comorbid anxiety and depression were significant determinants of the degree of functional impairment caused by dizziness [24]. However, several methodological limitations characterize these studies. First, only a few studies [13], [17], [18], [19], [25] included a sample of consecutive patients, thus eliminating a selection bias. Second, two studies [13], [15] assessed only a very limited number of psychiatric disorders. Finally, no study carefully compared the prevalence of categorical psychiatric disorders between patients with functional or psychogenic dizziness on the one hand, and patients with dizziness associated with specific organic conditions on the other hand.
Therefore, this study aimed: 1) to assess the criterion validity of mood and anxiety disorders as assessed by the PRIME-MD PHQ in otorhinolaryngology outpatients with a chief complaint of dizziness; and, 2) to assess the prevalence of current categorical mood and anxiety disorders and the severity of somatic complaints in a large consecutive sample of otorhinolaryngology outpatients presenting with a chief complaint of dizziness in a tertiary care setting.
Section snippets
Site and patients
From March to October 2000, new consecutive outpatients presenting with a chief complaint of dizziness at the otorhinolaryngology unit of a Belgian tertiary care hospital were asked to participate. All patients gave informed consent and the institutional ethical board approved the study protocol. Patients were excluded if they were: 1) younger than 15 years and older than 75 years; 2) unable to speak, read or write Dutch; 3) suffering from a psycho-organic or psychotic syndrome (judged by the
Patient characteristics
A total of 310 patients met the inclusion criteria of which 285 (91.9%) accepted to participate. There were no statistical differences in demographic characteristics and medical diagnoses between patients who accepted and patients who refused. Seventeen patients did not adequately complete the SDM, ADM and MDM of the PRIME-MD PHQ. They were significantly older than the patients who did complete these modules (respectively 58.3 years (SD 11.4) and 48.2 years (SD 12.9); t = −3.14; P = .002).
Discussion
The results indicated that in otorhinolaryngology outpatients with a chief complaint of dizziness, the PRIME-MD PHQ is a valuable screening and even diagnostic instrument for anxiety and mood disorders, especially for Any Depressive Disorder, Any Anxiety Disorder and Panic Disorder since the instrument generated valid information on the investigated disorders. Compared to the results obtained in primary care [9], obstetrics-gynecology [10], gastroenterology [11] and a general hospital setting
Conclusion
The present study supported the criterion validity of the PRIME-MD PHQ, an easy to use, self-administered instrument that could help the clinician to detect categorical psychiatric disorders in the otorhinolaryngological setting. The study further demonstrated a high prevalence of current categorical anxiety and mood disorders in a large sample of consecutive otorhinolaryngology outpatients with a chief complaint of dizziness and the differences in psychiatric status between patients with
Acknowledgements
We thank Lutgard Taminau and Gerda D'Hondt for collecting the data, Dorine Broekaert and Veronique De Gucht for their help in translating the PRIME-MD PHQ and Paul Enzlin and Iris Bombaert for their critical reading of this manuscript. This study was partly funded by a grant from the Belgian Ministry of Public Health and Social Affairs and supported by a grant from Pfizer Belgium.
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