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Purpose. This study investigated the relationships among four methods of detecting depression in patients with fibromyalgia. Methods. Data were obtained from 100 women [mean age 43 years) who had been diagnosed with fibromyalgia. Instruments included a computerized Diagnostic Interview Schedule (C-DIS), Beck Depression Inventory (BDI), an adjusted "disease-free" BDI [BDI-A), and Minnesota Multiphasic Personality Inventory depression subscale [MMPI-DJ. Chance-corrected concordance, sensitivity, specificity, and accuracy among the four methods were calculated.Results. The C-DIS detected 22% and BDI-A 29% with current major depression. The BDI and MMPI-D yielded higher estimates of 55% of the 44%, respectively. Agreement on the diagnosis among the four methods was significantly greater than chance. When compared with the C-DIS, the BDI was the most sensitive instrument and the BDI-A most specific.Conclusions. The C-DIS and BDI-A appear to be more reliable methods for determining the presence of major depression in women with fibromyalgia than are the MMPI-D or standard BDI.

Important life changes and significant psychological stress occur before, during, and after episodes of physical illness in the lives of many individuals. Significant life-adjustment or developmental difficulties have been shown to be associated with high use of medical services. This article calls attention to reduction in medical problems and use of medical facilities with referral for psychological services. On the assumption that psychologists can contribute significantly to reduction in patients' psychological stress levels and associated physical complaints, a new selfimage for many psychologists could be that of health care professional. Furthermore, this self-image and role could be implemented by having psychologists contribute to the treatment of patients in a continuous manner, starting with the initial patient visit to a health care facility.Medicine has recently shown great achievements in understanding mechanisms of disease, in developing new treatments, and in expanding technological capability. Yet the extent to which health care needs are being met continues to be questioned. Observers of the evolution of a biomedical model of disease are calling attention to the limits of explaining illness solely in terms of verifiable changes in biological function and structure (Engel, 1977;Leigh & Reiser, 1977;Lipowski, 1977;Weiner, 1977). According to Engel (1977) additional perspectives must be included in medicine for health care to have a sufficient impact on illness. Engel proposed a biopsychosocial model that takes into account the patient, the social context, and the health care system in which the patient has the opportunity to have his or her needs met. Weiner (1977) acknowledged that the mechanisms by which psychosocial stimuli are translated into v biological change remain unclear, yet he proposed an important role for psychological and social factors in the predisposition to, inception of, and maintenance of disease. Leigh and Reiser (1977) 420 • MAY 1979 • AMERICAN PSYCHOLOGIST