Psychometric Properties and Feasibility of the M-3 Checklist: A Brief, Self-Rated Screen for Depressive, Bipolar, Anxiety, and Posttraumatic Stress Disorders in Primary Care

Bradley N. Gaynes, MD, MPH; Joanne DeVeaugh-Geiss, LPA; Hongbin Gu, PhD; Sam Weir, MD; and David Rubinow, MD
The University of North Carolina, Chapel Hill

This poster presentation was supported by M-3 Information.

Background: Mood and anxiety are the two most common psychiatric disorders seen in primary care, yet they remain under-detected and under-treated. Screening tools can improve identification, but available instruments are limited by the number of disorders assessed.

Objective: To assess the feasibility and diagnostic validity of the M-3 checklist, a new one-page, patient-rated, 27-item tool developed to screen for multiple psychiatric disorders in primary care.

Design, Setting, and Participants: A sample of 647 consecutive participants 18 years and older who were seeking primary care at an academic family medicine clinic between July 2007 and February 2008. A two-step scoring procedure was utilized to make screening more efficient.

Main Outcome Measure(s): Sensitivity and specificity of the M-3 for major depression; bipolar disorder; anxiety disorders; and post-traumatic stress disorder (PTSD). Using a split sample technique, analysis proceeded from determination of optimal screening thresholds to assessment of the psychometric properties of the self-report instrument using the determined thresholds and the Mini International Neuropsychiatric Interview as the diagnostic standard. Feasibility was assessed with patient and physician exit questionnaires.

Results: The depression module had a sensitivity of 84% and a specificity of 80%. The bipolar module had a sensitivity 88%, and a specificity of 70%. The anxiety module had a sensitivity of 82% and a specificity of 78%, while the PTSD module had a sensitivity of 88% and a specificity of 76%. As a screen for any disorder, sensitivity was 83% and specificity was 76%. The M-3 took patients less than five minutes to complete in the waiting room, and less than 1% reported not having time to complete it. 83% of clinicians reviewed the checklist in 30 seconds, and 80% thought it was helpful in reviewing subjects’ emotional health.

Conclusions: The M-3 is a valid, efficient, and feasible tool for screening multiple common psychiatric illnesses, including bipolar disorder and PTSD, in primary care. Its diagnostic accuracy equals that of presently used single disorder screens but with the additional benefit of being combined into a one-page tool. The M-3 potentially can reduce missed psychiatric diagnoses and facilitate proper treatment of identified cases.

References
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613.

Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097.

Hirschfeld RM, Cass AR, Holt DC, et al. Screening for bipolar disorder in patients treated for depression in a family medicine clinic. J Am Board Fam Pract. 2005;18(4):233–239.

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