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This article examines the prevalence, nature, and comorbidity of depressive disorders using DSM-III-R criteria among patients recruited from the waiting rooms of family physicians. A total of 1928 family practice patients completed a screening form including the Center for Epidemiologic Studies-Depression Scale (CES-D), and patients with elevated CES-D scores were oversampled for possible interviews using the Structured Clinical Interview for the DSM-III-R (SCID). In the resulting weighted sample of 425, a prevalence of 13.5% was obtained for major depression and 22.6% for all depressive disorders. Over 40% of the patients with major depressive disorder (MDD) were only mildly depressed. Gender and other demographic variables failed to distinguish depressed patients, but a variety of self-ratings did. Depression was associated with comorbid anxiety disorders and substance abuse. Results are discussed in terms of the implications of depression in primary care as a public health problem, but also in terms of some diagnostic issues, particularly the use of an impairment criterion for major depression.

The relationship between self-reported depression and a clinical diagnosis of depression was investigated. Within 2 weeks of completing the Center for Epidemiologic Studies Depression Scale (CES-D), a stratified sample of 425 primary medical care patients received the structured interview for the DSM-III-R. In the weighted data set, the CES-D was significantly related to a diagnosis of depression but also to other Axis I disorders. Most distressed subjects were not depressed, a fifth of the patients with major depressive disorder (MDD) had low distress, and the CES-D performed as well in detecting anxiety as in detecting depression. MDD, other depression diagnoses, and anxiety and substance use disorders were all significant predictors of CES-D score. Differences in demographic variables, treatment history, and impairment highlight the nonequivalence of the self-report scale and diagnosable depression. The use of a self-report in place of an interview-based diagnostic measure in the study of depression, as well as the use of such a report as a screening device, is discussed.

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