Clinical vs. structured interview on anxiety and affective disorders by primary care physicians. understanding diagnostic discordance.
OBJECTIVE
To assess in a national sample the ability of GPs to detect psychiatric disorders using a clinical vs. a standardized interview and to characterize the patients that were falsely diagnosed with an anxiety or affective disorder.


METHODS
This is a national, cross-sectional, epidemiological survey, carried out by GPs on a random sample of their patients. The GPs were randomly divided into two groups. Apart from the routine clinical interview, the experimental group (group A) had to administer the Mini-International Neuropsychiatric Interview (MINI).


RESULTS
Data was collected by 143 GPs. 17.2% of all patients had a clinical diagnosis of an affective disorder, and 25.4% a clinical diagnosis of an anxiety disorder. In group A, the number of clinical diagnoses was about twice that of MINI diagnoses for affective disorders and one and a half times that for anxiety disorders. The majority of clinical diagnoses were represented by MINI subsyndromal cases (52.3%). Females showed a higher OR of being over-detected by GPs with anxiety disorders or of not being diagnosed with an affective disorder. Being divorced/separated/widowed increased the OR of over-detection of affective and anxiety disorders. The OR of over-detection of an affective or an anxiety disorder was higher for individuals with a moderate to poor quality of life.


CONCLUSIONS
In the primary care a gap exists between clinical and standardized interviews in the detection of affective and anxiety disorders. Some experiential and social factors can increase this tendency. The use of a psycho.
Balestrieri
Matteo
M
Clinica di Psichiatria e PMP, Dipartimento di Patologia e Medicina Sperimentale e Clinica, University of Udine, Udine, Italy. matteo.balestrieri@uniud.it
Baldacci
Sandra
S
Bellomo
Antonello
A
Bellantuono
Cesario
C
Conti
Luciano
L
Perugi
Giulio
G
Nardini
Marcello
M
Borbotti
Marco
M
Viegi
Giovanni
G
D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis*; D005104:Expert Testimony; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis*; D011320:Primary Health Care