Under-diagnosis of alcohol-related problems and depression in a family practice in Japan.
OBJECTIVE
The aim of this survey was to assess the accuracy of a family physician's diagnosis of depression and alcoholism.


METHODS
Consecutive new adult patients attending a family practice in Japan between April 2004 and August 2006 were enrolled. Excluded were those with dementia or visual disturbance, and emergency cases. Participants completed a questionnaire regarding their complaints and socio-demographics. A research nurse conducted the Japanese version of the Mini-International Neuropsychiatric Interview (J-MINI) in the interview room. The doctor independently performed usual practice and recorded his own clinical diagnoses. A researcher listed the clinical diagnoses and complaints, including J-MINI or clinically-diagnosed alcoholism and depression, using the International Classifications for Primary Care, Second Edition (ICPC-2) and calculated kappa statistics between the J-MINI and clinical diagnoses.


RESULTS
Of the 120 adult first-visit patients attending the clinics, 112 patients consented to participate in the survey and were enrolled. Fifty-one subjects were male and 61 female, and the average age was 40.7 +/- 13.2 years. Eight alcohol-related disorders and five major depressions were diagnosed using the J-MINI, whereas no cases of alcoholism and eight depressions were diagnosed by the physician. Clinically overlooked patients tended to have acute illnesses like a common cold. Concordance between the clinical and research diagnosis was achieved only for three episodes of Major depression, resulting in a kappa statistic of 0.43.


CONCLUSIONS
Although almost half of the major depressions were identified, all alcoholism was missed. A mental health screening instrument might be beneficial in family practice, especially to detect alcoholism.
Yamada
Kenshi
K
Department of Psychiatry, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan. kenshi_yamada@tmgh.metro.tokyo.jp.
Maeno
Tetsuhiro
T
Waza
Kazuhiro
K
Sato
Takeshi
T