Nondetection of depression by primary care physicians reconsidered

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Abstract

This article examines the rates of detection for major depression and other depressive disorders by family physicians as well as the differences between detected and undetected cases in terms of a variety of demographic and clinical variables. A total of 1,580 family practice patients completed a screening form and were rated by their physician. Patients with elevated Center for Epidemiologic Studies-Depression Scale (CES-D) scores were oversampled for possible interviews using the Structured Clinical Interview for DSM-III-R (SCID). In the resulting weighted sample, family physicians detected 34.9% of cases of major depression and 27.9% of cases of any depressive disorder. Detection was associated with pharmacological and psychological intervention. However, the undetected cases tended to be mildly depressed and higher functioning. Presence of a current anxiety disorder facilitated detection. Overall, the mildness of undetected depression and associated impairment have implications for estimates of the consequences of primary care physicians' low rates of nondetection and for the development of interventional strategies to improve their performance.

References (45)

  • JL Coulehan et al.

    The efficiency of depression questionnaires for case finding in primary medical care

    J Gen Intern Med

    (1989)
  • S Fechner-Bates et al.

    The relationship of self-reported distress to depressive disorders and other psychopathology

    J Consult Clin Psychol

    (1994)
  • SF Jencks

    Recognition of mental distress and diagnosis of mental disorder in primary care

    JAMA

    (1985)
  • PD Gerber et al.

    Recognition of depression by internists in primary care: a comparison of internist and “gold standard” psychiatric assessments

    J Gen Intern Med

    (1989)
  • M VonKorff et al.

    Anxiety and depression in a primary care clinic: comparison of diagnostic interview schedule, general health questionnaire, and practitioner assessments

    Arch Gen Psychiatry

    (1987)
  • EJ Perez-Stable et al.

    Depression in medical outpatients: underrecognition and misdiagnosis

    Arch Intern Med

    (1990)
  • J Ormel et al.

    Recognition, management, and course of anxiety and depression in general practice

    Arch Gen Psychiatry

    (1991)
  • HC Schulberg et al.

    Six-month outcomes for medical patients with major depressive disorders

    J Gen Intern Med

    (1987)
  • P Freeling et al.

    Unrecognized depression in general practice

    Br Med J

    (1985)
  • DP Goldberg

    The concept of a “case” in general practice

    Soc Psychiatry

    (1994)
  • LI Sireling et al.

    Depression in general practice: case thresholds and diagnosis

    Br J Psychiatry

    (1985)
  • I Elkin et al.

    National Institute of Mental Health Treatment of Depression Collaborative Research Program

    Arch Gen Psychiatry

    (1989)
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