Development and validation of the Client Diagnostic Questionnaire (CDQ): a mental health screening tool for use in HIV/AIDS service settings

Abstract

This study examines the validity, feasibility, and utility of the Client Diagnostic Questionnaire (CDQ), a brief diagnostic screening tool designed for use by non-mental health professionals and designed specifically to assess the range of psychiatric disorders known to be prevalent among persons infected with HIV or at high risk of infection: depression, anxiety, PTSD, substance abuse. Non-clinically trained personnel administered the CDQ to a diverse sample of 260 HIV infected individuals at six primary care or social service agencies; a second interview was conducted by an experienced mental health clinician. There was good agreement between positive screen on the CDQ and diagnosis made by an independent mental health professional. For the diagnosis of any disorder, sensitivity = 91%, specificity = 78%, and overall accuracy = 85%. Clients who screened positive for disorder based on the CDQ interview had significantly impaired mental health functioning compared to individuals without CDQ screening diagnosis. CDQ was well received by both clients and agency staff. Findings support the feasibility and utility of the CDQ. The CDQ can be used by providers in a range of service settings to identify persons in need of formal mental health assessment and treatment, to more effectively target scarce mental health resources, and to reduce the negative impact of unrecognized disorder on the health and well-being of individuals in their care.

Acknowledgements

Funding for the validation study was provided by Health Resources and Services Administration, HIV/AIDS Bureau 1BRH 970181-01. Special thanks is due to Robert L. Spitzer, MD and Janet B. Williams, DSW who provided invaluable assistance in developing the CDQ screening instrument, designing the validation study, and preparation of this manuscript. Thanks also to Miriam Gibbon, MSW who helped train the clinician interviewers.

Notes

The CDQ was developed as part of a national, multi-site evaluation study of medical and social service programmes that had received demonstration grants from either Health Resources Services Administration (HRSA) Special Projects of National Significance (SPNS) Programme or the Housing and Urban Development (HUD) Housing Opportunities for Persons with AIDS (HOPWA) Multiple Diagnoses Initiative.

The CDQ was developed based on DSM-IV diagnostic criteria, prior to the publication of the DSM-IV TR revisions (American Psychiatric Association, 2000). However, there are no DSM-IV-TR changes in diagnostic criteria for any of the disorders that are covered by the CDQ. Thus the screening tool would yield the same results following either diagnostic system.

The original protocol called for re-interview within three days of initial screening interview; however, the logistics of arranging return of clients for face to face assessment by a clinician within 3 days proved to be impossible for many, especially among clients residing in rural areas with difficult transportation needs. The use of phone re-interviews by clinicians was not an option due to limited phone coverage among AIDS service populations, especially those seen in homeless service programmes. In addition, client comfort and candor when discussing sensitive topics is less among vulnerable populations which would compromise the integrity of the instrument comparison in unknown ways (for recent review see, Holbrook et al., 2003).

A CDQ Interviewers Training Manual and additional training resources were developed in collaboration with Cicatelli Associates, Inc. Development of training materials was supported by a grant from the US Health Resources and Services Administration (HRSA) through the New York City Department of Health to the Medical and Health Research Association of New York City, Inc. (#BRH890015-08-0). The CDQ instrument and training materials are available from the first author or from Cicatelli Associates, Inc. at http://www.cicatelli.org