The detection of depression in medical setting: a study with PRIME-MD.
BACKGROUND
Studies investigating the performance of instruments to detect major depressive disorder (MDD) have reported inconsistent results. Subsyndromal depression (SD) has also been associated to increased morbidity, and little is known about its detection in primary care setting. This study aimed to investigate the performance of the Primary Care Evaluation of Mental Disorders (PRIME-MD) to detect MDD and any depression (threshold at SD) in an outpatient unit of a teaching general hospital.


METHODS
Nineteen primary care physicians using the PRIME-MD evaluated 577 patients, 240 of them (75% female; mean age, 40.0 +/- 14.4), including all with MDD and a randomly subset of those without MDD, were evaluated by 11 psychiatrists using the Structured Clinical Interview Axis I Disorders, Patient Version (SCIDI/P) for DSM-IV as the standard instrument.


RESULTS
The kappa between the PRIME-MD and the SCID was 0.42 for the diagnosis of any depression and 0.32 for MDD. The distribution of the number of depressive symptoms per patient suggested the existence of a continuum between SD and MDD, and a high frequency of subjects with 4-6 symptoms (close to the cutoff for the diagnosis of MDD).


CONCLUSIONS
The sample has a modest size and is a subset of an original one.


CONCLUSIONS
A continuum between SD and MDD may in part explain the relatively low agreement for the diagnosis of MDD in our sample and possibly in other studies. Studies investigating the performance of screening instruments to detect MDD, should consider the relevance of identifying SD, and the influence of the distribution of the number of depressive symptoms in their results.
Fraguas
Renerio
R
Department and Institute of Psychiatry, Faculty of Medicine, University of Sao Paulo, Brazil. rfraguas@partners.org
Henriques
Sergio Gonsalves
SG
Gonsalves Henriques
Sergio
S
De Lucia
Mara S
MS
Iosifescu
Dan V
DV
Schwartz
Faye H
FH
Menezes
Paulo Rossi
PR
Rossi Menezes
Paulo
P
Gattaz
Wagner Farid
WF
Farid Gattaz
Wagner
W
Martins
Milton Arruda
MA
Arruda Martins
Milton
M
D000041:Absenteeism; D000328:Adult; D000553:Ambulatory Care; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006769:Hospitals, General; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010552:Personality Assessment / Q000706:statistics & numerical data*; D011320:Primary Health Care; D011567:Psychiatric Department, Hospital; D011594:Psychometrics; D012017:Referral and Consultation; D015203:Reproducibility of Results