Clinimetric: The SPHERE 12 has high internal consistency (PSYCH 0.90, SOMA 0.80) and test-retest reliability (PSYCH 0.81, SOMA 0.80) in general practice (Hickie et al

2001a, Hickie et al 2001b). When detecting lifetime occurrence of any mental disorder in a young adult community sample, trained psychologists found fair agreement (kappa = 0.39) between the broad screen (a positive score selleck inhibitor on PSYCH and/or SOMA) of the SPHERE 12 and the Composite International Diagnostic Interview (CIDI) (the gold standard for psychiatric diagnosis) (McFarlane et al 2008). The same study also reported an area under the Receiver Operator Curve (ROC) of 72.9 for the PSYCH subscale and 71.5 for the SOMA subscale. Substantial agreement was found between the PSYCH subscale and the HADS (Hospital Anxiety and Depression Scale) when the threshold score was 2 (kappa = 0.67) or 3 (kappa = 0.73) in a sample of cancer patients (Clover et al 2009). When the broad screen is used in general practice, it has high sensitivity (93%) and low specificity (20%), for detecting mental disorders. If the narrow screen (a positive score on PSYCH click here and SOMA subscales) is used, the SPHERE 12 shows a low sensitivity (47%) and

high specificity 72% ( Clarke and McKenzie 2002). Early identification of mental health disorders is essential for optimum patient care. The most appropriate setting for early detection is primary care. Physiotherapists in primary care

are commonly exposed to patients with diagnostic labels such as chronic fatigue syndrome or ongoing, unexplained pain. Epidemiological and genetic research has shown that there are strong links between non-specific somatic symptoms and anxiety and depression (Hansell et al 2011, Katon et al 2007) and this may lead to these disorders being missed (McFarlane et al 2008). Using a tool to screen for mental disorders is likely to help early identification and improved care. The SPHERE 12 is a potentially good candidate for this role because it is easy to apply and brief. The broad screen also has the advantage of high sensitivity, which means that ‘at risk cases’ Ketanserin are unlikely to be missed. However, it also has low specificity and only fair validity when compared with the CIDI, the gold standard of psychiatric diagnosis. This combination of features indicates a significant number of false positive ‘cases’ will be identified using the SPHERE 12 screen and this could lead to unnecessary and costly investigations (Phillips et al 2002). Consideration of a number of factors might make this tool more appealing to the primary care clinician. First, the suggested thresholds may not be the most appropriate to detect different mental health disorders in the primary care setting, (see Table in McFarlane et al 2008 p. 341).