title: Psychiatric caseness is a marker of major depressive episode in general practice.
abstract: OBJECTIVE
  Screening for a major depressive episode (MDE) in high-risk groups of patients within the primary care setting has been suggested by several Central Health Organizations. The objective of this study was to investigate whether patients rated as "psychiatric cases" by their general practitioner (GP) were likely to suffer from MDE and therefore qualified for systematic diagnostic screening.
  
  
  METHODS
  Cross-sectional survey of primary care patients assessed through depression screening questionnaires and GP consultations.
  
  
  METHODS
  A total of 676 general practices in Denmark, Finland, Norway, and Sweden. Subjects. A total of 8879 unselected primary care patients.
  
  
  METHODS
  sensitivity, specificity, and Youden Index of the GPs' diagnoses of depression and psychiatric caseness versus patients' MDE status.
  
  
  RESULTS
  The proportion of primary care patients receiving a false-positive diagnosis of depression by their GP ranged from 12.4% to 25.2% depending on country. The corresponding numbers for the false-negative diagnoses were 0.9-2.5% [corrected]. Among patients with MDE, GPs recognize the disease in 56-75% of cases. However, GPs recognize as many as 79-92% of patients with MDE as "psychiatric cases".
  
  
  CONCLUSIONS
  This report confirms that misclassifications of MDE are common in the primary care setting. In addition, it shows that psychiatric caseness is a valid marker for the presence of MDE in primary care patients. This relationship should be considered in future screening recommendations.
authors.affiliation: Aalborg Psychiatric Hospital, Aarhus University Hospital, Denmark. soerendinesen@gmail.com
authors.forename: Søren Dinesen
authors.initials: SD
authors.lastname: Ostergaard
authors.forename: Leslie
authors.initials: L
authors.lastname: Foldager
authors.forename: Christer
authors.initials: C
authors.lastname: Allgulander
authors.forename: Alv A
authors.initials: AA
authors.lastname: Dahl
authors.forename: Marja-Terttu
authors.initials: MT
authors.lastname: Huuhtanen
authors.forename: Ib
authors.initials: I
authors.lastname: Rasmussen
authors.forename: Povl
authors.initials: P
authors.lastname: Munk-Jørgensen
mesh_terms: D003430:Cross-Sectional Studies; D003718:Denmark; D003865:Major Depressive Disorder / Q000145:classification / Q000175:diagnosis*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005194:Family Practice; D005387:Finland; D006801:Humans; D008403:Mass Screening; D001523:Mental Disorders / Q000145:classification / Q000175:diagnosis; D009664:Norway; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013548:Sweden