Recognition of depression by internists in primary care: a comparison of internist and "gold standard" psychiatric assessments.
In an effort to elucidate the process of internists' recognition of depression in primary care settings, a comparison of internist and "gold standard" psychiatric assessments of patients was undertaken in a rural primary care practice over a 15-month period. Clinical characteristics and diagnoses, global assessments of psychosocial stress, and two aspects of chief-complaint presentation style, clarity and somatization, were recorded by the internists for each patient, who was independently assessed by a psychiatrist for the presence of any specific depressive disorder by structured interview. Internists correctly labeled 57% of the interview-assessed depressives as depressed; 13% of patients with "no psychiatric disorder" were assessed as depressed by internists. Clinical and demographic characteristics of the "false-negative" and "false-positive" internists' diagnoses were examined to clarify how internists think of "depression" in the primary care context.
Gerber
P D
PD
Department of Medicine, Dartmouth Medical School, Hanover, NH 03756.
Barrett
J
J
Barrett
J
J
Manheimer
E
E
Whiting
R
R
Smith
R
R
D000328:Adult; D002983:Clinical Competence; D003863:Depression / Q000175:diagnosis*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D009513:New Hampshire; D010821:Physicians, Family; D011320:Primary Health Care / Q000592:standards*; D011569:Psychiatric Status Rating Scales; D012424:Rural Population