A Short, Psychiatric, Case-Finding Measure for HIV Seropositive Outpatients

Abstract

The author assesses performance characteristics of the 5-item mental health scale (MHI-5) of the Medical Outcomes Study Short Form Health Survey when used as a psychiatric case-finding measure for human immunodeficiency virus (HIV) seropositive outpatients. Ninety-five HIV seropositive outpatients from two primary care practices were recruited and cross-sectionally studied. All subjects completed the MHI-5. Standardized Clinical Interview for DSM-III-R (SCID-NP-HIV) was used as the gold standard in assessing Axis I psychiatric disorders in the previous 6 months. Thirty-three of 95 (35%) subjects had Axis I disorders (Axis I): 18 of 33 (55%) had a diagnosis of major depression (MD); 15 of 33 (45%) had another diagnosis (AD). Areas under receiver operator characteristic (ROC) curves were 0.76 (95% confidence interval [CI], 0.65, 0.87; Axis I), 0.84 (95% CI, 0.74, 0.94; MD), and 0.55 (95% CI, 0.38, 0.72; AD). The area under the MD curve was significantly greater than that for the AD curve (P = 0.0017). The optimal subscale score cut-off point on the MD curve was 52. Test characteristics for this cut-off point were: sensitivity, 83%; specificity, 65%; positive predictive value, 36%; negative predictive value, 94%; likelihood ratio for a positive test, 2.37; and likelihood ratio for a negative test, 0.26. The MHI-5 is the first short psychiatric case-finding measure for which performance characteristics have been reported for HIV seropositive outpatients. Test characteristics suggest that it may be a useful case-finding measure for these patients. A positive finding may indicate a diagnosis of recent major depression.