False Positives, False Negatives, and the Validity of the Diagnosis of Major Depression in Primary Care

Klinkman, Michael S.; Coyne, James C.; Gallo, Susan; Schwenk, Thomas L.

doi:10.1001/archfami.7.5.451

Cited by 108 publications

(75 citation statements)

References 38 publications

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“…29,30 They seem to use non-specific clinical cues such as distress and impairment, as well as their knowledge of the patient, in diagnosing the illness. 31 Mild depressive symptoms and psychological emotional problems can be associated with significant functional impairment, which physicians may feel inclined to address. 30 Patients, however, may not all expect to receive a prescription when consulting the physician.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Initiation of antidepressant therapy: do patients follow the GP's prescription?

Geffen¹,

Gardarsdóttir²,

Hulten³

et al. 2009

Br J Gen Pract

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Retrospective study linking a general practice to a pharmacy dispensing database. SettingGeneral practice in the Netherlands. MethodStudy population: patients who received a first-time antidepressant prescription from a GP. Three patient groups were identified: patients who did not fill the prescription (non-fillers); patients who filled only a single prescription (single Rx-fillers); and patients who filled at least two consecutive prescriptions. Non-fillers and single Rx-fillers were combined into a group of decliners. ResultsOf all 965 patients, 41 (4.2%) did not fill the prescription, and 229 (23.7%) filled only a single prescription. Patients who consulted their GP for a non-specific indication, rather than for depression, anxiety, panic, or obsessive-compulsive disorder, were almost three times more likely (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.8 to 3.9) to decline treatment. Further, the risk of declining was almost fivefold higher (OR = 4.8, 95% CI = 2.1 to 11.3) in nonWestern immigrants, and almost twofold higher (OR = 1.8, 95% CI = 1.2 to 2.8) in patients >60 years of age. ConclusionOver one in four patients who receive a first-time antidepressant prescription decline treatment; they either do not initiate drug taking or do not persist with antidepressant use for longer than 2 weeks.

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Section: Comparison With Existing Literaturementioning

confidence: 99%

Initiation of antidepressant therapy: do patients follow the GP's prescription?

Geffen¹,

Gardarsdóttir²,

Hulten³

et al. 2009

Br J Gen Pract

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show abstract

“…The diagnosis of depression is also influenced by other patient characteristics: females and older patients are more likely to be diagnosed with depression (Bertakis et al, 2001;Klinkman et al, 1998;Potts et al, 1991). Latelife depression in primary care settings is often incorrectly diagnosed and inadequately treated (Tai-Seale et al, 2005).…”

Section: Detection and Management Of Mdd In Primary Carementioning

confidence: 99%

Diagnosing Mental Health Disorders in Primary Care: Evaluation of a New Training Tool

Satter

2012

PsycEXTRA Dataset

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Major Depressive Disorder (MDD) and Posttraumatic Stress Disorder (PTSD) are highly prevalent illnesses that can result in profound impairment (Alegria et al., 2006; CTPTSD, 2007). While many patients with these disorders present in primary care, research suggests that physicians under-detect and suboptimally manage MDD and PTSD in their patients Satter et al., 2012). The development of more effective training interventions to aid primary care providers in diagnosing mental health disorders is of the utmost importance. This research focuses on evaluating computer-based training tools

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“…First, our analysis was based on an ethnically diverse sample in contrast to studies in which the patients were predominantly white. 54,55 Second, our study focused exclusively on patients over the age of 65 years in primary care settings. 56 Third, we were able to link the patient data to reports of physician identification of depression and somatization simultaneously within 6 months of interview.…”

Section: 48-53mentioning

confidence: 99%

A Cross-Sectional Study of Somatic Symptoms and the Identification of Depression Among Elderly Primary Care Patients

Bogner

Shah²,

Vries³

2009

Prim. Care Companion J. Clin. Psychiatry

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omatization, the presentation of medically unexplained symptoms, is very common in primary care.Objective: To examine the relationship between somatization and depression as rated by primary care physicians.Method: This study was a cross-sectional survey of 355 older adults with and without significant depressive symptoms. Physicians' ratings of somatization and depression were obtained for 341 of the 355 patients. Patients were sorted into 4 groups on the basis of physician ratings (no depression/no somatization, somatization only, depression only, and both somatization and depression). Data were collected from [2001][2002][2003].Results: Patients who were rated as somatizing were 4.03 (95% CI, 2.52-6.45) times as likely to be rated as depressed as well as somatizing. A comparison of the 4 groups defined by physicians' ratings found that functional status, ethnicity, number of medical conditions, depressive symptoms, and anxiety were statistically significantly different (P < .05). Primary care physicians were 3.95 (95% CI, 1.53-10.16) times more likely to identify older black patients as somatizing only versus depressed and somatizing compared to older white patients among patients above a threshold on a standard depression instrument.Conclusions: Our study fills a gap in the literature by focusing on the primary care physician ratings of depression and somatization, and also specifically on older primary care patients. Blacks are less likely to be rated as depressed, but this may reflect the tendency of doctors to rate them as somatizing.

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False Positives, False Negatives, and the Validity of the Diagnosis of Major Depression in Primary Care

Cited by 108 publications

References 38 publications

Initiation of antidepressant therapy: do patients follow the GP's prescription?

Initiation of antidepressant therapy: do patients follow the GP's prescription?

Diagnosing Mental Health Disorders in Primary Care: Evaluation of a New Training Tool

A Cross-Sectional Study of Somatic Symptoms and the Identification of Depression Among Elderly Primary Care Patients

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