Recognition of Depressive Symptoms by Physicians

Abstract

OBJECTIVE:To investigate the recognition of depressive symptoms of major depressive disorder (MDD) by general practitioners.INTRODUCTION:MDD is underdiagnosed in medical settings, possibly because of difficulties in the recognition of specific depressive symptoms.METHODS: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.RESULTS: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%).DISCUSSION: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.CONCLUSIONS: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.

Anxious depression and early changes in the HAMD-17 anxiety-somatization factor items and antidepressant treatment outcome

“…This finding is in contrast to others (Bech et al, 2009) who have not found that change in appetite, as measured by the HAMD-17, is sensitive to response. Despite the possibility that this is a chance finding, it is also possible that early changes in somatic symptoms (gastrointestinal) may be linked to antidepressant treatment outcome, which is consistent with studies suggesting a relationship between somatic symptoms and depression (Henriques et al, 2009; Mussell, et al, 2008; Trivedi, 2004). Additionally, there is evidence that change in appetite is suggestive of relapse and improvement in treatment (Kanai et al, 2003; Trivedi, 2004).…”

Family functioning of elderly with depressive symptoms

“…A study seeking to identify depressive symptoms in the elderly in the general outpatient setting of the Hospital das Clínicas, in São Paulo (Brazil), concluded that the presence of comorbidities may decrease the sensitivity of physicians to specific symptoms of depression, causing them to consider the symptoms as psychological reactions resulting from other diseases (4) .…”

“…Financial support is important, but care for the elderly with depressive symptoms also includes listening, observation, care and support whenever needed. Understanding the functioning of the elderly with depression can subsidize planning of care in order to meet their social and health needs (4,13) .…”

Prevalence and diagnostic distribution of medically unexplained painful somatic symptoms across 571 major depressed outpatients

“…Frequently, clinical presentations may include the presence of painful (PSSs) as well as nonpainful somatic symptoms (NPSSs) 1. Nonetheless, somatic symptoms in the course of MDE often go underestimated2 despite their impact on the course of illness and treatment choices. In fact, when inappropriately recognized and treated, (medically unexplained) somatic symptoms – considered as symptoms otherwise not referable to nonpsychiatric disturbances – are associated with poor prognosis, higher risk for residual symptomatology, as well as increased risk for relapse and recurrence 3–6.…”