Outcomes of recognized and unrecognized depression in an international primary care study

Simon, Gregory E.; Goldberg, Sir David; Tiemens, Bea; Üstün, T. B.

doi:10.1016/s0163-8343(98)00072-3

Cited by 155 publications

(145 citation statements)

References 37 publications

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“…Rates of identification (diagnostic sensitivity) ranged from a low of 19.3% in Nagasaki, Japan to 74.0% in Santiago de Chile, Chile. 23,24 In a related report from the WHO study, Munitz et al reported on diagnostic rates of depression in a subset of 1199 patients in six countries. 25 They found substantial differences and suggested that these might result from difficulties conceptualising depression by the physician and not necessarily differences in clinical presentation.…”

Section: Diagnostic and Statistical Manual Of Mental Disordersmentioning

confidence: 99%

“…High rates of diagnostic sensitivity (≥50%) were found in Manchester, Paris, Santiago, Seattle, and Verona, and low rates (≤20%) in Ankara, Athens, Ibadan, Nagasaki, and Shanghai. 23 The current study used an entirely different approach to the large interview-based study reported by Simon et al 23 Data were pooled from multiple studies of physician practices in five countries (four in the case of specificity). Studies with similar case-ascertainment and criterion standards were used to enhance comparability.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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International comparison of clinicians' ability to identify depression in primary care: meta-analysis and meta-regression of predictors

Mitchell¹,

Rao²,

Vaze³

2011

Br J Gen Pract

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A meta-analysis of unassisted clinical diagnoses against semi-structured interviews. MethodA systematic literature search, critical appraisal, and pooled analysis were conducted and 25 international studies were identified involving 8917 individuals. A minimum of three independent studies per country were required to aid extrapolation. ResultsClinicians in the Netherlands performed best at case finding (the ability to rule in cases of depression with minimal false positives) (AUC+ 0.735) and this was statistically significantly better than the ability of clinicians in Australia (AUC+ 0.622) and the US (AUC+ 0.653), who were the worst performers. Clinicians from Italy had intermediate case-finding abilities. Regarding screening (the ability to rule out cases of no depression with minimal false negatives) there were no strong differences. Looking at overall accuracy, primary care physicians in Italy and the Netherlands were most successful in their diagnoses and physicians from the US and Australia least successful (83.5%, 81.9%, 74.3%, and 67.0%, respectively). GPs in the UK appeared to have the lowest ability to detect depression, as a proportion of all cases of depression (45.6%; 95% CI = 27.7% to 64.2%). Several factors influenced detection accuracy including: collecting data on clinical outcomes; routinely comparing the clinical performance of staff; working in small practices; and having long waits to see a specialist. ConclusionAssuming these differences are representative, there appear to be international variations in the ability of primary care physicians to diagnose depression, but little differences in screening success. These might be explained by organisational factors.

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Section: Diagnostic and Statistical Manual Of Mental Disordersmentioning

confidence: 99%

Section: Comparison With Existing Literaturementioning

confidence: 99%

International comparison of clinicians' ability to identify depression in primary care: meta-analysis and meta-regression of predictors

Mitchell¹,

Rao²,

Vaze³

2011

Br J Gen Pract

View full text Add to dashboard Cite

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“…Studies suggest that, compared with psychiatrists, primary care physicians more often fail to detect mental disorders, [15][16][17] make more diagnostic errors, 18,19 and more often use inappropriate or inadequate dosages of psychotropic medications. 20,21 However, not every study comparing psychiatrists and primary care physicians have found significant treatment differences.…”

mentioning

confidence: 99%

Family Medicine Outpatient Encounters are More Complex Than Those of Cardiology and Psychiatry

Katerndahl¹,

Wood²,

Jaén³

2011

The Journal of the American Board of Family Medicine

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Background:Comparison studies suggest that the guideline-concordant care provided for specific medical conditions is less optimal in primary care compared with cardiology and psychiatry settings. The purpose of this study is to estimate the relative complexity of patient encounters in general/family practice, cardiology, and psychiatry settings.Methods: Secondary analysis of the 2000 National Ambulatory Medical Care Survey data for ambulatory patients seen in general/family practice, cardiology, and psychiatry settings was performed. The complexity for each variable was estimated as the quantity weighted by variability and diversity.Results: There is minimal difference in the unadjusted input and total encounter complexity of general/family practice and cardiology; psychiatry's input is less complex. Cardiology encounters involved more input quantitatively, but the diversity of general/family practice input eliminated the difference. Cardiology also involved more complex output. However, when the duration of visit is factored in, the complexity of care provided per hour in general/family practice is 33% more relative to cardiology and 5 times more relative to psychiatry.Conclusions: Care during family physician visits is more complex per hour than the care during visits to cardiologists or psychiatrists. This may account for a lower rate of completion of process items measured for quality of care. (J Am Board Fam Med 2011;24:6 -15.)

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“…Recognition of depression is less than optimal in primary care (3), although there is conflicting data on whether recognition of depression improves patient outcomes (4,5). To address these unanswered questions, we followed a cohort of elderly men with type 2 diabetes over a 10-year period to evaluate the effect of depression on risk of death, determine whether this risk differs by race/ ethnicity, and determine whether persistent recognition of depression is associated with decreased mortality.…”

mentioning

confidence: 99%

Effect of Race/Ethnicity and Persistent Recognition of Depression on Mortality in Elderly Men With Type 2 Diabetes and Depression

2008

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OBJECTIVE -To determine whether mortality risk from depression among elderly men with type 2 diabetes differs by ethnicity and persistent recognition of depression.RESEARCH DESIGN AND METHODS -Data on a cohort of 14,500 male veterans with type 2 diabetes were analyzed. Diagnoses of depression and diabetes were based on ICD-9 codes. Persistent recognition was defined as an ICD-9 code for depression documented in at least the second or third visit after the initial diagnosis of depression. Hazards of death were compared using Cox proportional hazards regression models adjusting for relevant covariates. CONCLUSIONS -Increased mortality from depression differs by ethnicity and persistent recognition. RESULTS Diabetes Care 31:880-881, 2008C oexisting depression increases the risk of death in people with diabetes (1,2); however, there is scant data on the effect of ethnic differences on mortality. Recognition of depression is less than optimal in primary care (3), although there is conflicting data on whether recognition of depression improves patient outcomes (4,5). To address these unanswered questions, we followed a cohort of elderly men with type 2 diabetes over a 10-year period to evaluate the effect of depression on risk of death, determine whether this risk differs by race/ ethnicity, and determine whether persistent recognition of depression is associated with decreased mortality. We hypothesized that: 1) comorbid depression would be associated with increased mortality, 2) there would be no significant differences in mortality by race/ethnicity, and 3) persistent recognition of depression would be associated with decreased mortality.

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Outcomes of recognized and unrecognized depression in an international primary care study

Cited by 155 publications

References 37 publications

International comparison of clinicians' ability to identify depression in primary care: meta-analysis and meta-regression of predictors

International comparison of clinicians' ability to identify depression in primary care: meta-analysis and meta-regression of predictors

Family Medicine Outpatient Encounters are More Complex Than Those of Cardiology and Psychiatry

Effect of Race/Ethnicity and Persistent Recognition of Depression on Mortality in Elderly Men With Type 2 Diabetes and Depression

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