title: Diagnostic accuracy and adequacy of treatment of depressive and anxiety disorders: A comparison of primary care and specialized care patients.
abstract: BACKGROUND
  Clinical diagnosis of depressive and anxiety disorders has poor sensitivity, and treatment is often not guideline-concordant. This longitudinal study aims to compare diagnostic validity and treatment adequacy in primary care (PC) and specialized care (SC), to assess associated risk factors, and to evaluate their impact on clinical outcome at one-month and three-month follow-ups.
  
  
  METHODS
  Two hundred twelve patients with depressive and anxious symptoms were recruited from 3 PC and 1 SC centers in Barcelona, Spain. Sensitivity and specificity were calculated comparing medical records׳ diagnoses with a reference (MINI interview). Adequate treatment was defined according to clinical guidelines. Logistic regression was used to estimate associations with risk factors. Impact on outcome was assessed with MANOVA models.
  
  
  RESULTS
  Valid diagnosis of depression was more frequent in patients attending SC. Sensitivity for depression was 0.75 in SC and 0.49 in PC (adjusted OR=17.34, 95% CI=4.73-63.61). Detection of anxious comorbidity in depressed patients was low (50%) in SC. Treatment adequacy of depressive disorders was higher in SC than in PC (94.4% vs. 80.6%, adjusted OR=8.11, 95% CI=1.39-47.34). Depression severity was associated with valid diagnosis.
  
  
  CONCLUSIONS
  Only four disorders (major depression, dysthymia, panic disorder and generalized anxiety disorder) were evaluated with the MINI interview in a convenience clinical sample. Treatment dosage was unavailable.
  
  
  CONCLUSIONS
  Our results suggest that GPs need tools to improve detection of depression and its severity. Psychiatrists should enhance recognition of anxious comorbidity. Evaluation of the impact on outcome deserves further research.
authors.affiliation: Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, Barcelona, Spain; Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain.
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Castro-Rodríguez
authors.affiliation: Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Olariu
authors.affiliation: Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, Barcelona, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Garnier-Lacueva
authors.affiliation: Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, Barcelona, Spain.
authors.forename: Luis Miguel
authors.initials: LM
authors.lastname: Martín-López
authors.affiliation: Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Spain; CIBER de Salud Mental (CIBERSAM), Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Pérez-Solà
authors.affiliation: Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain. Electronic address: jalonso@imim.es.
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
authors.affiliation: Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Forero
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards*; D011570:Psychiatry / Q000592:standards*; D012307:Risk Factors; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D013030:Spain
keywords: Anxiety; Depression; Guideline adherence; Mental health services; Primary health care; Sensitivity and specificity