Patient presentation, interview content, and the detection of depression by primary care physicians.

Abstract

This study was undertaken in order to better understand the detection of depression by primary care physicians. Specifically, we investigated the relationship between information gathered during the course of the medical interview and the subsequent diagnosis of depression. Forty-seven community-based primary care physicians, unaware of the mental health focus of this research, were videotaped in the office setting, as they interviewed two "typical" standardized patients who met DSM-III-R criteria for major depression. One patient presented with headaches and the other presented with palpitations and chest pain. After each interview, physicians were provided with physical findings and results of any diagnostic procedures they ordered, then asked to construct and explicate their differential diagnoses. The two patients were correctly diagnosed as depressed by 53 and 45% of the physicians. Although detection was related to greater amounts of information gathered, inquiry about the DSM-III-R criteria symptoms was generally low, and in no case was sufficient information acquired to make a formal DSM-III-R diagnosis of depression. However, a subset of the DSM-III-R symptoms (those related to disturbances of appetite, sleep, and other neurovegetative functions) were among the reasons cited for inclusion of depression in the differential, as were psychosocial stressors and the patient's appearance. These findings suggest that detection of depression is low by primary care physicians.

Standardized Clients in the Classroom: A Novel Instructional Technique for Social Work Educators

“…SC encounters are designed to simulate actual student-client interactions with a high degree of realism. The literature reports convincing evidence, and our own experience concurs that simulators can recreate medical signs (Barrows, 1971;Barrows & Abrahamson, 1964; and psychological or psychosocial information (Badger, deGruy, Hartman, Plant, Leeper, Anderson, et al, 1994;Badger, deGruy, Hartman, Plant, Leeper, Ficken, et al, 1994;Badger et al, 1995) with great fidelity. Therefore, SCs can be utilized by educators to ensure that all students experience the variety of clients and specific client problems fundamental to competent practice.…”

Recognition and treatment of depression in primary care: Effect of patients' presentation and frequency of consultation

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Community survey of factors associated with consultation for low back pain

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