title: A comparison of GP and GDS diagnosis of depression in late life among multimorbid patients - results of the MultiCare study.
abstract: BACKGROUND
  The objective of the study was to compare General Practitioners׳ (GPs) diagnosis of depression and depression diagnosis according to Geriatric Depression Scale (GDS) and to identify potential factors associated with both depression diagnosis methods.
  
  
  METHODS
  The data were derived from the baseline wave of the German MultiCare1 study, which is a multicentre, prospective, observational cohort study of 3177 multimorbid patients aged 65+ randomly selected from 158 GP practices. Data were collected in GP interviews and comprehensive patient interviews. Depressive symptoms were assessed with a short version of the Geriatric Depression Scale (15 items, cut-off 6). Cohen׳s kappa was used to assess agreement of GP and GDS diagnoses. To identify factors that might have influenced GP and GDS diagnoses of depression, binary logistic regression analyses were performed.
  
  
  RESULTS
  Depressive symptoms according to GDS were diagnosed in 12.6% of the multimorbid subjects, while 17.8% of the patients received a depression diagnosis by their GP. The agreement between general practitioners and GDS diagnosis was poor. To summarize we find that GPs and the GDS have different perspectives on depression. To GPs somatic and psychological comorbid conditions carry weight when diagnosing depression, while cognitive impairment in form of low verbal fluency, pain and comorbid somatic conditions are relevant for a depression diagnosis by GDS.
  
  
  CONCLUSIONS
  Each depression diagnosing method is influenced by different variables and therefore, has advantages and limitations. Possibly, the application of both, GP and GDS diagnoses of depression, could provide valuable support in combining the different perspectives of depression and contribute to a comprehensive view on multimorbid elderly in primary care setting.
authors: Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany. Electronic address: Michaela.Schwarzbach@medizin.uni-leipzig.de.
authors: Michaela
authors: M
authors: Schwarzbach
authors: Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
authors: Melanie
authors: M
authors: Luppa
authors: Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Heike
authors: H
authors: Hansen
authors: Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Hans-Helmut
authors: HH
authors: König
authors: Institute for General Practice, Friedrich-Schiller-University Hospital, Jena, Germany.
authors: Jochen
authors: J
authors: Gensichen
authors: Institute for General Practice, Goethe-University of Frankfurt am Main, Frankfurt am Main, Germany.
authors: Juliana J
authors: JJ
authors: Petersen
authors: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Gerhard
authors: G
authors: Schön
authors: Institute for Biometry, Hannover Medical School, Hannover, Germany.
authors: Birgitt
authors: B
authors: Wiese
authors: Central Institute of Mental Health, Mannheim, Germany.
authors: Siegfried
authors: S
authors: Weyerer
authors: Department of Psychiatry, Technical University of Munich, München, Germany.
authors: Horst
authors: H
authors: Bickel
authors: Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
authors: Angela
authors: A
authors: Fuchs
authors: Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
authors: Wolfgang
authors: W
authors: Maier
authors: Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Hendrik
authors: H
authors: van den Bussche
authors: Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Martin
authors: M
authors: Scherer
authors: Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
authors: Steffi G
authors: SG
authors: Riedel-Heller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis* / Q000523:psychology*; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology*; D005260:Female; D058006:General Practice; D015577:Geriatric Assessment; D005858:Germany; D006801:Humans; D016015:Logistic Models; D008297:Male; D011320:Primary Health Care; D011446:Prospective Studies
keywords: Diagnosis of depression; General practitioner; Late life; Multimorbidity; Prevalence; Primary care