title: Unlocking the diagnosis of depression in primary care: Which key symptoms are GPs using to determine diagnosis and severity?
abstract: OBJECTIVE
  Diagnosing depression in primary care settings is challenging. Patients are more likely to present with somatic symptoms, and typically with mild depression. Use of assessment scales is variable. In this context, it is uncertain how general practitioners (GPs) determine the severity of depressive illness in clinical practice. The aim of the current paper was to identify which symptoms are used by GPs when diagnosing depression and when determining severity.
  
  
  METHODS
  A total of 1760 GPs participated in the RADAR Program, an educational program focusing on the diagnosis and management of clinical depression. GPs identified a maximum of four patients whom they diagnosed with depression and answered questions regarding their diagnostic decision-making process for each patient.
  
  
  RESULTS
  Overall, assessment of depression severity was influenced more by somatic symptoms collectively than emotional symptoms. Suicidal thoughts, risk of self-harm, lack of enjoyment and difficulty with activities were amongst the strongest predictors of a diagnosis of severe depression.
  
  
  CONCLUSIONS
  The conclusions are threefold: (1) collectively, somatic symptoms are the most important predictors of determining depression severity in primary care; (2) GPs may equate risk of self-harm with suicidal intent; (3) educational initiatives need to focus on key depressive subtypes derived from emotional, somatic and associated symptoms.
authors.affiliation: CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, Australia Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia gin.malhi@sydney.edu.au.
authors.forename: Gin S
authors.initials: GS
authors.lastname: Malhi
authors.affiliation: CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, Australia Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Carissa M
authors.initials: CM
authors.lastname: Coulston
authors.affiliation: CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, Australia Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Kristina
authors.initials: K
authors.lastname: Fritz
authors.affiliation: CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, Australia Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Lampe
authors.affiliation: CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, Australia Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Bargh
authors.affiliation: MediMark International, Seaford, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Ablett
authors.affiliation: Mood Disorders Unit, Northside Clinic, Greenwich, Australia.
authors.forename: Bill
authors.initials: B
authors.lastname: Lyndon
authors.affiliation: Albany Hills Radius Medical Centre, Brendale Radius Medical Centre, Brisbane, Australia.
authors.forename: Rick
authors.initials: R
authors.lastname: Sapsford
authors.affiliation: Mood Disorders Programme, New Farm Clinic, Brisbane, Australia.
authors.forename: Mike
authors.initials: M
authors.lastname: Theodoros
authors.affiliation: MediMark International, Seaford, Australia.
authors.forename: Derek
authors.initials: D
authors.lastname: Woolfall
authors.affiliation: MediMark International, Seaford, Australia.
authors.forename: Andrea
authors.initials: A
authors.lastname: van der Zypp
authors.affiliation: Professorial Psychiatry Unit, Albert Road Clinic, University of Melbourne, Melbourne, Australia.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Hopwood
authors.affiliation: Psycho-oncology Department, University of Leicester, Leicester, UK.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Mitchell
mesh_terms: D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D016728:Self-Injurious Behavior / Q000523:psychology; D012720:Severity of Illness Index; D059020:Suicidal Ideation
keywords: Depression; diagnosis; general practice; primary care