An innovative 5-Step Patient Interview approach for integrating mental healthcare into primary care centre services: a validation study

Abstract

Background: Mental health problems are prevalent among patients seeking primary healthcare. However, traditional patient interviews often fail to identify and manage these problems. Therefore, an improved patient interview process is needed to assess and treat mental health problems in primary care settings.

Aims: To assess the validity, reliability, sensitivity and specificity of a 5-Step Patient Interview approach for the screening, diagnosis and treatment of mental health problems.

Design and setting: This study compared a 5-Step Patient Interview approach (AlKhathami approach) with expert psychiatric interviews based on the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7) questionnaire from 1 January 2020 to 30 April 2020 in family practice or primary healthcare centres.

Methods: A total of 760 participants from five Saudi Arabian regions were selected using a multiclustered random sample of every third patient aged ≥18 years, drawn from the clinics' patient list.

Results: A total of 732 patients agreed to participate, with a response rate of 96.3%; 396 (54.1%) were women; the mean (Standard Deviation) age was 41.28 (14.30) years (ranging from 18 to 84 years). Mental health problems were suspected in 40% of the participants. The 5-Step Patient Interview approach was shown to be comparable to an expert interview by a psychiatrist. Moreover, it was more accurate than the PHQ-9 and GAD-7 self-administered questionnaires in screening for stress and classifying it as mild, moderate to severe or severe. Additionally, the 5-Step Patient Interview approach improved physician-patient communication by encouraging the exploration of patients' perspectives.

Conclusions: The 5-Step Patient Interview approach is a valid, reliable tool that can aid the integration of mental healthcare into primary healthcare and family practice. Future studies should evaluate the implementation outcomes of the 5-Step Patient Interview approach.

Keywords: comprehension; interview, psychological; mental health; mental health services; patient care.

Figure 1

Flowchart of study enrolment. DSM-5, Diagnostic and Statistical Manual of Mental Disorders, fifth edition; GAD-7, Generalised Anxiety Disorder-7; MMSE, Mini-Mental State Examination; PHQ-9, Patient Health Questionnaire-9; SCID-5, Structured Clinical Interview for DSM Disorders, fifth edition.