Increased recognition of depression in primary care. Comparison between primary-care physician and ICD-10 diagnosis of depression.
BACKGROUND
Underrecognition and undertreatment of depression in primary care has been regarded as a major public health problem. In contrast, some studies found that among patients labeled as depressed by primary-care physicians (PCPs), a relevant proportion do not satisfy international diagnostic criteria for depression. The aims of this study are: (1) to assess disparity between PCP diagnosis and research diagnosis of depression; (2) to compare antidepressant treatment in concordant and discordant cases of depression.


METHODS
Data are gathered from a national survey on depressive disorders in primary care, conducted with the collaboration of 191 PCPs. Three hundred and sixty-one PCP patients were evaluated, and their psychiatric diagnosis was established by the 'unaided' PCPs and by using a research interview for depression.


RESULTS
PCPs recognized 79.4% of cases of depression and prescribed antidepressants to 40.9% of them. Yet, 45.0% of patients labeled as depressed by the PCPs were not cases of depression according to ICD-10 criteria; 26.9% of false-positive cases received an antidepressant. Globally, 35% of antidepressants for 'depression' were prescribed to false-positive cases.


CONCLUSIONS
Underrecognition and undertreatment of depression in primary care seem to be less alarming. Conversely, PCP diagnoses of depression appear to be more inclusive than psychiatric diagnostic criteria. A possible consequence of this apparently more inclusive diagnostic threshold may be an excessive use of antidepressants. These changes require a corresponding change in research, toward efficacy and safety of the treatment of milder cases, and in education, toward the distinction between the management of mild and severe cases of depression.
Berardi
Domenico
D
Institute of Psychiatry, Bologna University, Bologna, Italy. domenico.berardi@unibo.it
Menchetti
Marco
M
Cevenini
Nadia
N
Scaini
Sara
S
Versari
Matteo
M
De Ronchi
Diana
D
D000328:Adult; D000465:Algorithms; D000928:Antidepressive Agents / Q000627:therapeutic use; D002983:Clinical Competence; D003866:Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D003951:Diagnostic Errors; D005189:False Positive Reactions; D005260:Female; D006306:Health Surveys; D006801:Humans; D038801:International Classification of Diseases; D007406:Interview, Psychological; D007558:Italy; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000193:education
D000928:Antidepressive Agents