Programme no. 458-P
MINI for assessment of depression and anxiety in primary care – is it feasible?
Ingvar Krakau1, Rolf Wahlström2, Agneta Pettersson*3, Sandra af Winklerfelt4
1CeFAM,Stockholm,Sweden, 2Public Health Sciences,Karolinska Institutet,Stockholm,Sweden, 3LIME,Karolinska Institutet,Stockholm,Sweden, 4CeFAM,Stockholm,Sweden
* = Presenting author
- To explore experiences of assessments with MINI in primary care;
- To explore whether referral to a counsellor or a psychologist for the assessment is acceptable.
Background: A correct diagnosis is vital for the best practice management of patients with mental ill-health. Diagnostic interviews like the structured Mini International Neuropsychiatric Interview (MINI) may facilitate the diagnosis. MINI has high diagnostic accuracy for depression and acceptable properties for anxiety disorders. It is well documented for use in psychiatry. The feasibility of MINI in primary care has not been described in the literature.
Most of the patients (80%) were referred to a psychologist or counsellor. The mean time for the assessment was 26 minutes; 53% were completed in 20 minutes or less, and 80% in 30 minutes or less. Most patients appreciated MINI showing a median global satisfaction of 80 on VAS (range 0-100), although six percent found the interview intrusive and three percent that it was too strenuous. Nearly 70% perceived that the assessment was useful. MINI helped the patients verbalize their problems and to admit symptoms that were shameful. The median global satisfaction was 93 on VAS (range 0-100) for being referred to a psychologist or a counsellor for the MINI assessment.
GPs appreciated the opportunity to refer patients for MINI and had also used the referral for patients outside the study. The assessment had helped to unveil co-morbidities, less common diagnoses, such as PTSD and bipolar II disorder, as well as to rule out psychiatric disorders for some seemingly depressed patients.
Material/Methods: Consecutive patients were recruited from three primary care centers (Mar 2014-Feb 2015). Patients for whom depression was a possible diagnosis according to specified inclusion criteria were assessed with MINI, either by the GP or by a psychologist or counsellor after referral from the GP. Data collection included structured questionnaires to patients (n=118) and assessors (n=114), semi-structured interviews with a purposive sample of patients (n=21), and focus groups with GPs (n=17).
Conclusion: This explorative study thus shows that MINI is feasible in primary care. Also, the time for the assessment was shorter than anticipated.
Points for discussion:
GPs preferred to refer patients for the MINI-assessment and patients highly appreciated to be assessed by a counsellor or a psychologist.
Patients appreciated a structured assessment as a complement to the patient-centered consultation.