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Clinical Predictors of Mental Disorders Among Medical Outpatients

Validation of the "S4" Model

Received December 7, 1997; revised February 3, 1998; accepted February 11, 1998. From the Departments of Medicine, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD; the Walter Reed Army Medical Center, Washington, DC; and the Regenstrief Institute for Health Care and Indiana University School of Medicine, Indianapolis, IN. Address reprint requests to Dr. Jackson, Dept of Medicine–EDP, USUHS, 4301 Jones Bridge Rd., Bethesda, MD 20814.

The authors previously reported four clinical cues that predicted a subgroup of ambulatory patients likely to have depressive and anxiety disorders. The authors' purpose in this study was to validate this model in another cohort of 185 consecutive adult referrals to a rheumatology clinic. The authors found 4 variables important in predicting mental disorders: recent stress (odds ratio [OR]: 3.3, 95% confidence interval [CI]: 1.5–7.1); >5 somatic symptoms (OR: 4.5, 95% CI: 1.1–9.5); only fair or poor health status (OR: 3.4, 95% CI: 1.6–7.4); and symptom severity (OR: 1.6, 95% CI: 0.8–3.6). There was a stepwise increase in the likelihood of a mental disorder with an increasing number of predictors. The authors conclude that these clinical cues may allow clinicians to select patients in which formal screening for mental disorders would be particularly fruitful.

Key Words: clinical predictors • mental disorders • S4 model

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