Brief report: Patient cognitive status and the identification and management of depression by primary care physicians

Crane, Monica K.; Bogner, Hillary R.; Rabins, Peter V.; Gallo, Joseph J.

doi:10.1111/j.1525-1497.2006.00559.x

Cited by 4 publications

(4 citation statements)

References 23 publications

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“…However, one of those was a retrospective chart review and the other, prospective, study involved older, well-established PD patients. We did not confirm earlier research that the presence of CI leads to overestimating of depression by doctors [ 40 ].…”

Section: Discussioncontrasting

confidence: 99%

“…They did somewhat better than the patients themselves. Compared to other studies, our neurologists’ diagnostic sensitivity for CI was lower than those of general practitioners (GP’s), although both had a high specificity [34-40]. Our data on the recognition of CI are in line with two earlier studies on PD patients, which both found the majority of symptoms going unrecognised and untreated.…”

Section: Discussionsupporting

confidence: 83%

“…Non-psychiatrist physicians appear not to do much better, as numerous studies have shown that they perform significantly worse than validated questionnaires [ 26 - 39 ]. The presence of CI also leads physicians to overestimate the presence of depression [ 40 ].…”

Section: Introductionmentioning

confidence: 99%

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Neurologists’ diagnostic accuracy of depression and cognitive problems in patients with parkinsonism

Bouwmans

Weber

2012

BMC Neurol

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BackgroundDepression and cognitive impairment (CI) are important non-motor symptoms in Parkinson’s Disease (PD) and related syndromes, but it is not clear how well they are recognised in daily practice. We have studied the diagnostic performance of experienced neurologists on the topics depression and cognitive impairment during a routine encounter with a patient with recent-onset parkinsonian symptoms.MethodsTwo experienced neurologists took the history and examined 104 patients with a recent-onset parkinsonian disorder, and assessed the presence of depression and cognitive impairment. On the same day, all patients underwent a Hamilton Depression Rating Scale test, and a Scales for Outcomes in Parkinson’s Disease-Cognition-test (SCOPA-COG).ResultsThe sensitivity of the neurologists for the topic depression was poor: 33.3%. However, the specificity varied from 90.8 to 94.7%. The patients’ sensitivity was higher, although the specificity was lower. On the topic CI, the sensitivity of the neurologists was again low, in a range from 30.4 up to 34.8%: however the specificity was high, with 92.9%. The patients’ sensitivity and specificity were both lower, compared to the number of the neurologists.ConclusionsNeurologists’ intuition and clinical judgment alone are not accurate for detection of depression or cognitive impairment in patients with recent-onset parkinsonian symptoms because of low sensitivity despite of high specificity.Trial registration(ITRSCC)NCT0036819.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 83%

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Neurologists’ diagnostic accuracy of depression and cognitive problems in patients with parkinsonism

Bouwmans

Weber

2012

BMC Neurol

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“…26 The prevalence rates of depression in people with cognitive impairment range from 4.9% to 43.7% depending on the diagnostic criteria used. 34 Crane et al 33 noted that physicians who identified a patient as cognitively impaired were more likely to diagnose them as depressed or to treat them for depression than physicians with patients without a diagnosed cognitive impairment. The changes in cognitive functioning that occur early in the stages of cognitive impairment resemble depression, making the differentiation difficult and crucial because depression is a more treatable condition than dementia.…”

Section: Mcguire Et Al 504mentioning

confidence: 98%

The Prevalence of Depression in Older U.S. Women: 2006 Behavioral Risk Factor Surveillance System

McGuire

Strine

Vachirasudlekha

et al. 2008

Journal of Women's Health

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Depression, a type of mood disorder, is associated with psychological distress and suffering, and it can lead to impairments in physical, mental, and social functioning. The goal of this commentary is to provide an estimate of the prevalence of current depression and lifetime diagnosis for 14,425 community-dwelling U.S. women aged 65 and older. Using information from the 2006 Behavioral Risk Factor Surveillance System (BRFSS), participants reported their lifetime diagnosis of depression and completed the Patient Health Questionnaire 8 to assess current depression and its severity. Our findings indicate that 5.9% of women 65 years old and older have current depression, 94.1% reported either no depressive symptoms or mild depressive symptoms, and 12.3% reported a lifetime diagnosis of depression. Mental health is integral to overall health and well-being and should be treated in older women with the same urgency as physical health. Depression is a mental health issue of particular concern for women, given their increasing numbers, higher proportion in the US population, and role as caregivers. Continued surveillance from a system such as the BRFSS is needed to track changes in the mental health of older adults.

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Concordance Between Clinical Diagnosis and Medicare Claims of Depression Among Older Primary Care Patients

Hwang

Jayadevappa

Zee

et al. 2015

The American Journal of Geriatric Psychiatry

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Objective To identify patient characteristics associated with concordance of Medicare claims with clinically identified depression. Design Cohort of 742 older primary care patients linked to Medicare claims data. Measurements Structured Clinical Interview for DSM-IV major depressive disorder (MDD) and clinically-significant minor depression. Results Among 474 patients with depression, 198 patients had a Medicare claim for depression (sensitivity: 42%, 95% confidence interval (CI) 37% to 46%). Among 268 patients who did not meet criteria for depression, 235 patients did not have a Medicare claim for depression (specificity: 88%, 95% CI 83% to 91%). After adjustment for demographic and clinical characteristics, non-white participants were nearly twice as likely not to have Medicare claims for depression among patients who met criteria for depression (“false negatives”). Smoking status, depression severity (HDRS), cardiovascular disease, and more primary care physician office visits were also significantly associated with decreased odds to be false negatives. In contrast, after covariate adjustment, white race and chronic pulmonary disease were associated with increased odds of a Medicare claim for depression among patients who did not meet criteria for depression (“false positives”). Using weights based on the screened sample, the positive predictive value of a Medicare claim for depression was 66% (95% CI [63%, 69%]), while the negative predictive value was 77% (95% CI [76%, 78%]). Conclusion Investigators using Medicare data to study depression must recognize that diagnoses of depression from Medicare data may be biased by patient ethnicity and the presence of medical comorbidity.

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Brief report: Patient cognitive status and the identification and management of depression by primary care physicians

Cited by 4 publications

References 23 publications

Neurologists’ diagnostic accuracy of depression and cognitive problems in patients with parkinsonism

Neurologists’ diagnostic accuracy of depression and cognitive problems in patients with parkinsonism

The Prevalence of Depression in Older U.S. Women: 2006 Behavioral Risk Factor Surveillance System

Concordance Between Clinical Diagnosis and Medicare Claims of Depression Among Older Primary Care Patients

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