www.mymoodmonitor.com/

Bobbing along in the deluge of medical paraphernalia that can tend to flood my "inbox", a Medscape headline caught my eye this week. It was an interesting abstract via Medscape Psychiatry and reviewed an important current paper from the excellent primary care journal the Annals of Family Medicine.

The particular article described in detail the peer review and validation of a new tool for the detection of a range of mood and anxiety-related mental health disorders in primary care. The simple primary care tool - called the M3 or My Mood Monitor questionnaire - was designed for both patients and the primary care team in around 2007.

Appropriately, perhaps, the developers come from the University of North Carolina (UNC) or what we might call "provincial" US and had been motivated to develop and later validate such a tool that could reliably be used in primary care to pick up and identify mental health problems which might otherwise go unmanaged. Developmentally, the tool was the brainchild of primary collaborators Robert Post, head of the Bipolar Collaborative Network; Bernard Snyder, assistant clinical Professor of Psychiatry at Georgetown University; Gerald Hurowitz, assistant clinical Professor of Psychiatry at Columbia University and others.

The validation research group (headed by Bradley Gaynes) conducted a study of 650 patients at the UNC Family Practice Clinic and the study confirmed the validity of the M3 checklist as a diagnostic tool by utilising the Mini International Neuropsychiatric Interview as a control. This was published in March 2010 in the Annals of Family Medicine. The original paper is available as a PDF at www.annfammed.org/cgi/reprint/8/2/160

In essence, the M3 screen is a brief online symptom checklist and scoring system that allows the patient or clinician to rate mood and/or anxiety symptoms in one easy review. It comprises a short series of questions that touch on important indicators of the patient's mental health.

In recent months, we have been offered other free and locally developed tools with the Best Practice Depression module and this new M3 tool would certainly complement these. The other tools which do exist such as those optional choices in our Best Practice module do contain certain aspects of the M3 but this more recently validated free web-based tool would appear to be the only self-administered clinical device that integrates comprehensive patient self-rating of all the major mood and anxiety disorders. It is also claimed to be the first such instrument that includes patient education, and progress and side effect measurements covering the full course of treatment.

The team at Best Practice may not, of course, concur.

The screening responses and the resulting M3 risk assessment scores may be printed, faxed, emailed or securely stored and accessed online in a personal health record by a designated healthcare professional (via Microsoft Health Vault) all at the discretion of the user. The site also provides some parallel educational material for patients and their physicians, allowing the M3 to encourage treatment compliance and long-range follow-up of progress.

The "M3 Mood Monitor" provides a visual representation of the patient's progress in a graphic form, showing clearly how their symptoms might be responding to treatment, and whether and to what degree the ever-present confounding variables of adverse effects have been a problem. Thus, the M3 is able to be regularly and serially repeated and the ability to store those self-derived scores and even graph them is enticing. Additionally, having an increased pot of financial resources available for mental healthcare at the primary care level together with simple quality of life tools such as M3 for us and our increasingly skilled nursing staff to utilise quickly and simply is welcome indeed.

The developers also have questioned whether the M3 could possibly provide a single rating of general "mental wellbeing". Based on their individual M3 responses, each patient is assigned a single M3 score which represents the likelihood that the symptoms disclosed reflect a clinically significant disorder. On further validation the M3 tool did show that among patients with "no diagnosis" 83 per cent received an M3 score below 33, whereas 81 per cent of those with a confirmed "diagnosis" fell above this threshold. Thus, the higher the M3 score the more likely the patient's responses were to be clinically significant, and the symptoms reported were likely to be having a real impact on quality of life. Therefore, the M3 score could be viewed as a general mental wellbeing marker with lower scores indicative of "good mental health". For those receiving treatment, it also could provide a target for treatment success.
In a slightly more critical vein, Michael Klinkman from the University of Michigan Depression Centre agreed with Medscape Psychiatry the M3 checklist was a "good step forward" but it still did not address all the screening needs in a primary care centre.

"It does a good job of taking and condensing the questions we use to try and identify patients with depressive disorder, but it does not confirm a diagnosis," Dr Klinkman was quoted as saying in Medscape Psychiatry. For example, if a patient screens positive for bipolar disorder on the M3 checklist, they still have less than a one in four chance of actually having that disorder because the symptoms used in the screening test are lifetime symptoms, and, if patients answer "yes", that doesn't mean they are having symptoms now.

"As long as physicians understand this and they have a place where they can refer patients to in order to get the rest of the screening done, it's fine, but the checklist still leaves a lot of work for primary care physicians to do, and too many times, they simply do not have access to mental health experts or services to complete this process," Dr Klinkman commented. Sounds somewhat familiar.

And, having said all that, the M3 questionnaire (as with all depression questionnaires) tends to focus on "the last two weeks". We also know patients tend to go through "good patches" and "bad patches" and sometimes our attempts to over-medicalise the latter can be inappropriate in a world where stress is the "order of the day". After all, I was told of a "quick-and-dirty" survey some one to two years ago that suggested 40 per cent of Aucklanders would rather live out of Auckland. Perhaps a national M3 "quality of mental health" comparative survey starting south and north of the Bombay Hills might be interesting indeed.