Obstetrician-gynecologists' decision making about the diagnosis of major depressive disorder and premenstrual dysphoric disorder

Abstract

Major depressive disorder (MDD) is underdiagnosed and undertreated in ambulatory care settings including gynecologic practices. Far less is known about the diagnosis of Premenstrual Dysphoric Disorder (PMDD). Three hundred and thirty-five gynecologists responded to mailed questionnaires that used descriptive scenarios as analogues to clinical cases. Questionnaire recipients were randomly selected to receive either a MDD or PMDD version of the questionnaire. Respondents were less accurate when diagnosing MDD cases (48% accuracy; p = 0.526), than PMDD cases (80% accuracy; p < 0.001), but were significantly more confident about their probability ratings of MDD cases, t = 2.57, p < 0.02. Qualitative analysis suggested that less accurate MDD respondents did not prioritize case data according to DSM-IV criteria, whereas almost all PMDD respondents made use of valid reasoning strategies. Respondents did not take base rates into account when deciding about the probability of either affective disorder. Results imply that gynecologists employ cognitive strategies that result in accurate diagnostic judgments about PMDD, but overconfidence, lack of attention to DSM-IV criteria and base rate neglect could hinder clinical decisions about MDD, and may contribute to underdiagnosis of depression.

Does a Disconnect Occur Between Research and Practice for Premenstrual Dysphoric Disorder (PMDD) Diagnostic Procedures?

“…On the other hand, screening measures and interviews, particularly un-standardized interviews, have questionable validity and may be more subject to reporting biases. Results of one study indicated that physicians were 80% correct in identifying PMDD based on case studies derived from DSM criteria; however, this study also suggested that physicians tended to over-estimate the probability of PMDD given the low base rates for the disorder (Hill et al, 2005). It is unknown how the case study methodology used applies to real-world clinical practice.…”

“…It is unknown how the case study methodology used applies to real-world clinical practice. Use of standardized assessment instruments and/or decision-making tools may increase diagnostic accuracy and decrease the cognitive burden on physicians in making psychological diagnoses in medical settings (Hill et al, 2005). In consideration that no biological test (e.g., blood or biochemical) exists, it is of critical importance to establish methods for PMDD that are both valid and clinically useful.…”

United States obstetrician-gynecologists' accuracy in the simulation of diagnosing anxiety disorders and depression during pregnancy

“…Power analyses performed for similar surveys have indicated that the minimum number of surveys needed to ensure moderate effect size for power of 0.9 is about 100 [26]. A power analysis conducted for this study revealed power of 0.8 for a sample of 300 physicians.…”

Obstetrician-gynecologists' screening patterns for anxiety during pregnancy

“…Anxiety training could be more effective if anxiety disorders were more directly correspondent to ob-gyns' interests. Mental health diagnoses are more likely to be recognized, accurately diagnosed, and treated when they are more directly associated with pregnancy or the menstrual cycle [Hill et al, 2005]. Therefore, raising ob-gyns' awareness of the detrimental effects of anxiety during pregnancy specifically could increase interest in anxiety screening.…”