Improving Physicians?? Recognition and Treatment of Depression in General Medical Care

Magruder-Habib, Kathryn; Zung, William W. K.; Feussner, John R.

doi:10.1097/00005650-199003000-00004

Cited by 148 publications

(74 citation statements)

References 19 publications

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“…Of these, 16 met our full inclusion criteria ( Figure 1; Appendix 2, available online at www.cmaj.ca/cgi/content/full /178/8/997/DC2). [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The majority of studies were excluded because they involved a substantial enhancement of care (over and above screening) or were nonrandomized. Appendix 3 presents the excluded studies and the reasons for exclusion (available online at www.cmaj.ca/cgi/content/full/178/8/997/DC2).…”

Section: Search Resultsmentioning

confidence: 99%

Screening and case-finding instruments for depression: a meta-analysis

Gilbody¹,

Sheldon²,

House³

2008

Canadian Medical Association Journal

375

278

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Section: Search Resultsmentioning

confidence: 99%

Screening and case-finding instruments for depression: a meta-analysis

Gilbody¹,

Sheldon²,

House³

2008

Canadian Medical Association Journal

375

278

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“…Case-finding instruments enhance detection of major depression, and treatment of major depression improves outcomes. 38,39 However, studies conflict as to whether early detection and treatment of depression leads to improved outcomes compared with usual care given at the time symptoms are first recognized. 11,[40][41][42][43][44][45] Neither the U.S. Preventive Services Task Force nor the Canadian Task Force on the Periodic Health Examination has found sufficient evidence to recommend for or against the routine use of case-finding questionnaires for depression in primary care patients.…”

Section: Discussionmentioning

confidence: 99%

Case-finding instruments for depression

et al. 1997

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OBJECTIVE:To determine the validity of a two-question case-finding instrument for depression as compared with six previously validated instruments. DESIGN:The test characteristics of a two-question casefinding instrument that asks about depressed mood and anhedonia were compared with six common case-finding instruments, using the Quick Diagnostic Interview Schedule as a criterion standard for the diagnosis of major depression. SETTING:Urgent care clinic at the San Francisco Department of Veterans Affairs Medical Center. PARTICIPANTS:Five hundred thirty-six consecutive adult patients without mania or schizophrenia. MEASUREMENTS AND MAIN RESULTS:Measurements were two questions from the Primary Care Evaluation of Mental Disorders patient questionnaire, both the long and short forms of the Center for Epidemiologic Studies Depression Scale, both the long and short forms of the Beck Depression Inventory, the Symptom-Driven Diagnostic System for Primary Care, the Medical Outcomes Study depression measure, and the Quick Diagnostic Interview Schedule. The prevalence of depression, as determined by the standardized interview, was 18% (97 of 536). Overall, the case-finding instruments had sensitivities of 89% to 96% and specificities of 51% to 72% for diagnosing major depression. A positive response to the two-item instrument had a sensitivity of 96% (95% confidence interval [CI], 90-99%) and a specificity of 57% (95% CI 53-62%). Areas under the receiver operating characteristic curves were similar for all of the instruments, with a range of 0.82 to 0.89. CONCLUSIONS:The two-question case-finding instrument is a useful measure for detecting depression in primary care. It has similar test characteristics to other case-finding instruments and is less time-consuming. KEY WORDS: depression; case-finding instruments.

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“…Indeed, depression is less likely to be recognized in patients who present with somatic symptoms than in patients who present with predominantly psychological symptoms (Figure 3). 6,8,51 In 1985, Bridges and Goldberg 10 reported that primary care physicians misdiagnosed more than 50% of psychiatric patients who presented with somatic symptoms. In 1993, during a retrospective examination of consecutive patients at 2 primary care clinics in Canada, Kirmayer and colleagues 8 found that 78% of patients with major depression who had presented with a primary complaint of somatic symptoms had been misdiagnosed.…”

Section: Somatic Symptoms Decrease the Recognition Of Depressionmentioning

confidence: 99%

The Importance of Somatic Symptoms in Depression in Primary Care

Gandhi¹

2005

Prim. Care Companion CNS Disord.

240

186

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Objective:Patients with depression present with psychological and somatic symptoms, including general aches and pains. In primary care, somatic symptoms often dominate. A review of the literature was conducted to ascertain the importance of somatic symptoms in depression in primary care.Data sources and extraction: MEDLINE, EMBASE, and PsychLIT/PsychINFO databases ( -January 2004 were searched for the terms depression, depressive, depressed AND physical, somatic, unexplained symptoms, complaints, problems; somatised, somatized symptoms; somatisation, somatization, somatoform, psychosomatic; pain; recognition, underrecognition; diagnosis, underdiagnosis; acknowledgment, underacknowledgment; treatment, undertreatment AND primary care, ambulatory care; primary physician; office; general practice; attribution, reattribution; and normalising, normalizing. Only English-language publications and abstracts were considered.Study selection: More than 80 papers related to somatic symptoms in depression were identified using the content of their titles and abstracts.Data synthesis: Approximately two thirds of patients with depression in primary care present with somatic symptoms. These patients are difficult to diagnose, feel an increased burden of disease, rely heavily on health care services, and are harder to treat. Patient and physician factors that prevent discussion of psychological symptoms during consultations must be overcome.Conclusions: Educational initiatives that raise awareness of somatic symptoms in depression and help patients to reattribute these symptoms should help to improve the recognition of depression in primary care.( 3 Despite improved awareness of the condition in primary care, depression remains difficult to diagnose initially, and the majority of cases are only recognized at subsequent consultations, sometimes several years after the patient's initial visit. 4 In primary care, physicians require sophisticated consulting skills to enable them to differentiate a wide range of symptoms from a complex narrative in a short period of time. Symptoms of depression include classic psychological symptoms, such as low mood, loss of interest, poor concentration, and associated anxiety, and somatic symptoms, such as changes in appetite, lack of energy, sleep disturbance, and general aches and pains. 5,6 The suspicion of depression is usually raised by the presence of psychological symptoms. However, in approximately two thirds of patients with depression, the clinical picture is dominated by somatic symptoms, such as lack of energy and general aches and pains, 7,8 which patients frequently attribute to normalizing causes. As a result, many physicians become preoccupied with lengthy investigations into possible underlying organic disease rather than considering depression as a diagnosis.9 Indeed, depression is mostly difficult to recognize in patients who present with chiefly somatic complaints. 8,10 We conducted a review of the recent literature to ascertain the importance of somatic symptoms in depress...

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Improving Physicians?? Recognition and Treatment of Depression in General Medical Care

Cited by 148 publications

References 19 publications

Screening and case-finding instruments for depression: a meta-analysis

Screening and case-finding instruments for depression: a meta-analysis

Case-finding instruments for depression

The Importance of Somatic Symptoms in Depression in Primary Care

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