Recognition of Depressive Symptoms by Physicians

• Published in: Clinics (São Paulo, Brazil) Vol. 64; no. 7; pp. 629 - 635
• Main Authors: Henriques, Sergio Gonçalves, Fráguas, Renério, Iosifescu, Dan V., Menezes, Paulo Rossi, de Lucia, Mara Cristina Souza, Gattaz, Wagner Farid, Martins, Milton Arruda
• Format: Journal Article
• Language: English; Portuguese
• Published: Brazil Elsevier España, S.L.U 01.01.2009; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; Faculdade de Medicina / USP; Elsevier España
• Subjects: Adolescent; Adult; Ambulatory care; Ambulatory Care - standards; Ambulatory Care - statistics & numerical data; Clinical Sciences; Cross-Sectional Studies; Depression - diagnosis; Depression - psychology; Depressive disorder; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - psychology; Diagnosis; Diagnostic and Statistical Manual of Mental Disorders; False Negative Reactions; False Positive Reactions; Family Practice; Female; Humans; Internal medicine; Male; MEDICINE, GENERAL & INTERNAL; Primary care; Primary Health Care - standards; Primary Health Care - statistics & numerical data; Psychiatry; Sensitivity and Specificity; Severity of Illness Index; Socioeconomic Factors; Young Adult; Diagnosis; Internal medicine; Primary care; Ambulatory care; Depressive disorder
• ISSN: 1807-5932; 1980-5322; 1980-5322
• DOI: 10.1590/S1807-59322009000700004

To investigate the recognition of depressive symptoms of major depressive disorder (MDD) by general practitioners. MDD is underdiagnosed in medical settings, possibly because of difficulties in the recognition of specific depressive symptoms. A cross-sectional study of 316 outpatients at their first visit to a teaching general hospital. We evaluated the performance of 19 general practitioners using Primary Care Evaluation of Mental Disorders (PRIME-MD) to detect depressive symptoms and compared them to 11 psychiatrists using Structured Clinical Interview Axis I Disorders, Patient Version (SCID I/P). We measured likelihood ratios, sensitivity, specificity, and false positive and false negative frequencies. The lowest positive likelihood ratios were for psychomotor agitation/retardation (1.6) and fatigue (1.7), mostly because of a high rate of false positive results. The highest positive likelihood ratio was found for thoughts of suicide (8.5). The lowest sensitivity, 61.8%, was found for impaired concentration. The sensitivity for worthlessness or guilt in patients with medical illness was 67.2% (95% CI, 57.4–76.9%), which is significantly lower than that found in patients without medical illness, 91.3% (95% CI, 83.2–99.4%). Less adequately identified depressive symptoms were both psychological and somatic in nature. The presence of a medical illness may decrease the sensitivity of recognizing specific depressive symptoms. Programs for training physicians in the use of diagnostic tools should consider their performance in recognizing specific depressive symptoms. Such procedures could allow for the development of specific training to aid in the detection of the most misrecognized depressive symptoms.