Depression in medical outpatients: underrecognition and misdiagnosis

Article Abstract:

The majority of patients with emotional disorders seek help from primary care physicians, rather than from mental health professionals. Furthermore, it is estimated that from 25 to 75 percent of patients in primary care settings have psychosocial ailments, rather than biomedical disorders. Medical charts were used to retrospectively analyze the diagnosis of 265 medical outpatients. The diagnoses made by the physician were compared with diagnoses which were made by comparing chart data to the Diagnostic Interview Schedule (DIS). Based on chart material and the DIS, 70 patients had either major depression or chronic minor depression. The primary care physician recognized this in only 25 cases (35.7 percent). Furthermore, depression was diagnosed by the physician in 36 cases (13.6 percent) where the diagnosis was inaccurate according to DIS criteria. These patients were generally older and less educated. The study also evaluated different scales for the clinical analysis of depression and compared them with the DIS, which is regarded as the standard against which other criteria may be compared. The Beck Depression Inventory was found to be superior to the Center for Epidemiological Studies Depression scale. Although clinicians both underdiagnose and misdiagnose depression, the diagnosis of depression can never be made from self-report scales, which are only intended to screen for patients who should be given a more detailed interview. (Consumer Summary produced by Reliance Medical Information, Inc.)

Affective disorders, Mood disorders, Dosage and administration, Antidepressants

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Depression: underrecognition and undertreatment by psychiatrists and other health care professionals

Article Abstract:

In the May 1990 issue of the Archives of Internal Medicine, Perez-Stable and colleagues document that many primary care physicians are failing to detect the presence of depression in their patients. They are not alone in this shortcoming; many psychiatrists apparently fail to recognize and inadequately treat many cases of depression. The situation is serious; one study has indicated that as many as half of all depressed patients first seek help from a general practitioner, rather than from a psychiatrist. The resulting failure of diagnosis is especially unfortunate, since many cases of depression respond readily to antidepressant medication after the condition is properly recognized. Although the selection of the subjects and the retrospective review of medical histories are possible sources of bias in the Perez-Stable study, the results are consistent with other reports of under-recognition and undertreatment of depression. In a major study by the NIMH involving 955 depressed patients and 2,600 first degree relatives, low levels of treatment were observed. Prior to entering the study, only 34 percent had received adequate treatment for four consecutive weeks. There may be a tendency to perceive depressed patients as malingerers who are 'not really sick'. Nonetheless, depressed patients are severely debilitated people deserving of prompt, adequate medical treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Mental illness, Psychiatric diagnosis, editorial

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The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression

Article Abstract:

The National Depressive and Manic-Depressive Association held a consensus conference bringing together professionals in psychiatry, psychology, family practice, and internal medicine; managed care and public health officials; and consumers and the general public. The group agreed that depression is being seriously undertreated, at substantial cost to depressed individuals and society. Reasons for undertreatment include factors relating to patients, caregivers, and the health care system. Strategies to improve care include patient and caregiver education, developing better collaboration between doctors and mental health professionals, and developing managed care treatment guidelines and payment mechanisms.

Research, Depression and Bipolar Support Alliance

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