The effect of patient and visit characteristics on diagnosis of depression in primary care.
OBJECTIVE
The purpose of our study was to determine if factors other than the patient' clinical presentation were associated with the likelihood of depression being recognized during a physician office visit.


METHODS
We used a cross-sectional design.


METHODS
Data from the 1997 and 1998 National Ambulatory Medical Care Surveys were examined.


METHODS
We assessed the association of factors such as age, sex, race, physician specialty, type of insurance, and visit duration with a recorded depression diagnosis during office visits to primary care physicians.


RESULTS
After controlling for symptom presentation, primary care physicians were 56% less likely to record a diagnosis of depression during visits made by elderly patients, 37% less likely to do so during visits by African Americans, and 35% less likely to do so during visits by Medicaid patients. Visits with a depression diagnosis were, on average, 2.9 minutes longer in duration (16.4 vs 19.3) than visits without a depression diagnosis. Family practice and general practice physicians were 65% more likely to record a diagnosis of depression than internists.


CONCLUSIONS
Many factors were associated with making and recording a depression diagnosis beyond the patient' reported symptoms. If rates of diagnosis are to improve, interventions that go beyond getting physicians to recognize the symptoms of depression are needed.
Harman
J S
JS
Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St, Suite 430, Pittsburgh, PA, 15213, USA. harmanjs@msx.upmc.edu.
Schulberg
H C
HC
Mulsant
B H
BH
Reynolds
C F
CF
D000328:Adult; D017677:Age Distribution; D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003625:Data Collection; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D005194:Family Practice / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology