Psychosomatic Medicine, Vol 56, Issue 2 128-135, Copyright © 1994 by American Psychosomatic Society

ORIGINAL ARTICLES

Patient presentation, interview content, and the detection of depression by primary care physicians

LW Badger, FV deGruy, J Hartman, MA Plant, J Leeper, R Anderson, R Ficken, S Gaskins, A Maxwell, E Rand and al. et
School of Social Work, University of Alabama School of Medicine, Tuscaloosa 35487-0326.

This study was undertaken in order to better understand the detection of depression by primary care physicians. Specifically, we investigated the relationship between information gathered during the course of the medical interview and the subsequent diagnosis of depression. Forty-seven community-based primary care physicians, unaware of the mental health focus of this research, were videotaped in the office setting, as they interviewed two "typical" standardized patients who met DSM-III-R criteria for major depression. One patient presented with headaches and the other presented with palpitations and chest pain. After each interview, physicians were provided with physical findings and results of any diagnostic procedures they ordered, then asked to construct and explicate their differential diagnoses. The two patients were correctly diagnosed as depressed by 53 and 45% of the physicians. Although detection was related to greater amounts of information gathered, inquiry about the DSM-III-R criteria symptoms was generally low, and in no case was sufficient information acquired to make a formal DSM-III-R diagnosis of depression. However, a subset of the DSM-III-R symptoms (those related to disturbances of appetite, sleep, and other neurovegetative functions) were among the reasons cited for inclusion of depression in the differential, as were psychosocial stressors and the patient's appearance. These findings suggest that detection of depression is low by primary care physicians.

This article has been cited by other articles:

				A. M. Heneghan, L. H. Chaudron, A. Storfer-Isser, E. R. Park, K. J. Kelleher, R. E. K. Stein, K. E. Hoagwood, K. G. O'Connor, and S. M. Horwitz Factors Associated With Identification and Management of Maternal Depression by Pediatricians Pediatrics, March 1, 2007; 119(3): 444 - 454. [Abstract] [Full Text] [PDF]

				A. Karasz and L. Watkins Conceptual Models of Treatment in Depressed Hispanic Patients Ann. Fam. Med, November 1, 2006; 4(6): 527 - 533. [Abstract] [Full Text] [PDF]

				K. T. J. L. Ensinck, A. G. Schuurman, M. van den Akker, J. F. M. Metsemakers, A. D. M. Kester, J. A. Knottnerus, and F. Buntinx Is There an Increased Risk of Dying after Depression? Am. J. Epidemiol., December 1, 2002; 156(11): 1043 - 1048. [Abstract] [Full Text] [PDF]

				C. Grant, R. Nicholas, L. Moore, and C. Salisbury An observational study comparing quality of care in walk-in centres with general practice and NHS Direct using standardised patients BMJ, June 29, 2002; 324(7353): 1556 - 1556. [Abstract] [Full Text] [PDF]

				A. G. Schuurman, M. van den Akker, K. T.J.L. Ensinck, J. F.M. Metsemakers, J. A. Knottnerus, A. F.G. Leentjens, and F. Buntinx Increased risk of Parkinson's disease after depression: A retrospective cohort study Neurology, May 28, 2002; 58(10): 1501 - 1504. [Abstract] [Full Text] [PDF]

				R. Waxman, A. Tennant, and P. Helliwell Community survey of factors associated with consultation for low back pain BMJ, December 5, 1998; 317(7172): 1564 - 1567. [Abstract] [Full Text]

				P. R. Muskin The Request to Die: Role for a Psychodynamic Perspective on Physician-Assisted Suicide JAMA, January 28, 1998; 279(4): 323 - 328. [Abstract] [Full Text] [PDF]