The problem of diagnosing major depression in elderly primary care patients.
BACKGROUND
To clarify the problem of diagnosing major depression in elderly primary care patients, we studied the nuances of diagnostic classification by general practitioners (GPs) and the relationship between sociodemographic and clinical factors and an accurate diagnosis of depression.


METHODS
As part of a national survey of general practice a standardised psychiatric interview (CIDI) was performed in 237 subjects > or =55 years screened for the presence of psychopathology. Fifty-five patients were found to suffer from a major depressive disorder in the last 12 months. In these patients, GPs registered during 1 year all contact diagnoses and prescriptions of medication.


RESULTS
Nearly all depressed patients (96.4%) had one or more contacts with their GP during 1 year. GPs classified 20.8% of the patients as having a down/depressed feeling or depression, while 32.1% as having other psychological problems than depression. It was remarkable that an accurate diagnosis by GPs was significantly related to higher age in this age group. Regarding the clinical characteristics, there was a significantly higher number of prescriptions of antidepressants in the accurately diagnosed patients. We found no significant differences in respect to other clinical characteristics (e.g. severity and number of symptoms, comorbidity of anxiety and somatic disorders).


CONCLUSIONS
GPs are aware of the psychological problems in half of the elderly patients with major depression, but do not explicitly distinguish depressive symptoms from other psychological problems or from social problems. Integrated programs may be more promising to improve the diagnostic rate than clinical education or guideline implementation alone.
NIVEL (Netherlands Institute for Health Services Research), Drieharingstraat 6, PO box 1568, 3500 NB Utrecht, Netherlands. a.volkers@nivel.nl
Anita C
AC
Volkers
Jasper
J
Nuyen
Peter F M
PF
Verhaak
François G
FG
Schellevis
D000367:Age Factors; D000368:Aged; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D000928:Antidepressive Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D003937:Diagnosis, Differential; D004363:Drug Utilization / Q000706:statistics & numerical data; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
D000928:Antidepressive Agents