Is major depression adequately diagnosed and treated by general practitioners? Results from an epidemiological study

Gen Hosp Psychiatry. Mar-Apr 2010;32(2):201-9. doi: 10.1016/j.genhosppsych.2009.11.015. Epub 2010 Jan 12.

Abstract

Objectives: The aim of this study was to (1) to explore the validity of the depression diagnosis made by the general practitioner (GP) and factors associated with it, (2) to estimate rates of treatment adequacy for depression and factors associated with it and (3) to study how rates of treatment adequacy vary when using different assessment methods and criteria.

Methods: Epidemiological survey carried out in 77 primary care centres representative of Catalonia. A total of 3815 patients were assessed.

Results: GPs identified 69 out of the 339 individuals who were diagnosed with a major depressive episode according to the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) (sensitivity 0.22; kappa value: 0.16). The presence of emotional problems as the patients' primary complaint was associated with an increased probability of recognition. Rates of adequacy differed according to criteria: in the cases detected with the SCID-I interview, adequacy was 39.35% when using only patient self-reported data and 54.91% when taking into account data from the clinical chart. Rates of adequacy were higher when assessing adequacy among those considered depressed by the GP.

Conclusion: GPs adequately treat most of those whom they consider to be depressed. However, they fail to recognise depressed patients when compared to a psychiatric gold standard. Rates of treatment adequacy varied widely depending on the method used to assess them.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Catchment Area, Health
  • Clinical Competence*
  • Cognition Disorders / diagnosis
  • Cognition Disorders / epidemiology
  • Depressive Disorder, Major* / diagnosis
  • Depressive Disorder, Major* / drug therapy
  • Depressive Disorder, Major* / epidemiology
  • Diagnosis, Differential
  • Diagnostic and Statistical Manual of Mental Disorders
  • Epidemiologic Studies
  • Female
  • Guidelines as Topic
  • Humans
  • Male
  • Mental Health Services / standards*
  • Middle Aged
  • Neuropsychological Tests
  • Primary Health Care / methods*
  • Primary Health Care / statistics & numerical data*
  • Recognition, Psychology
  • Sampling Studies
  • Severity of Illness Index
  • Spain / epidemiology
  • Surveys and Questionnaires
  • Treatment Outcome