Recognition of major depressive disorder and its correlates among adult male patients in primary care

Abstract

Background and aims. Primary care is one of the first points of contact for patients with major depressive disorder (MDD). However, before primary care centers can become effective referral points, it is essential to know the prevalence and current rates of detection of MDD in those centers. We aimed to determine the prevalence of MDD and its sociodemographic correlates in a primary care center and to evaluate the accuracy of the primary care physicians' diagnosis.Methodology. This is an observational cross-sectional study conducted in a rural primary health care center on adult male attendees. PHQ-9 was used to screen for depression, which was confirmed by a psychiatrist who interviewed and diagnosed patients using the DSM-5 criteria. A primary care physician separately examined each patient for depression.Results. Out of 335 adult male patients, 22.1% screened positive with PHQ-9 and 42 patients (12.5 %) had MDD Primary care physicians diagnosed only 45% of cases correctly, missing 55%. The correlation between the two physicians' and the psychiatrist's diagnosis had a Kappa of 0.342 and 0.281, respectively. Significant sociodemographic correlates were self-reported financial stress and life stressors.Discussion. MDD prevalence was consistent with studies in other countries. The physicians' diagnosis may have been an overestimation due to the Hawthorne effect.Conclusion. Primary care physicians were unable to diagnose a significant fraction of the depression. This emphasizes the need for further training at this level, to improve early diagnosis and referral rates. depression, men, family practice

Under detection of depression in primary care settings in low and middle-income countries: A systematic review and meta-analysis

“…Five studies did not report the background of the PHC clinicians 21–25 . Regarding training, four studies (two cross-country studies and two additional individual studies) confirm that they did not provide additional mental health training or other intervention prior to the assessment 20 23 28 19 while the remaining six studies do not provide such information 21 22 24–27 .…”

“…The study among men adult clinic attendees reported detection of 69.0% with just two physician assessors 27 . The study carried out among pregnant women who were joining ANC follow up reported a detection of 1.4% (n=3/218) 26 .…”

“…Regarding the setting, 12 reports were based in primary care clinics [19][20][21][22][23] , four studies in general hospitals where patients had direct access from the community 19 24 and one primary care clinic for patients with diabetes 25 and one primary maternal care clinic 26 . One study recruited men only participants 27 . 19 20 .…”

Association of Antioxidant to the Genesis of Psychiatric Disorder

“…One unit of GSH-Px is characterized as micromoles of NADPH oxidized every moment. Action was given in units per liter plasma volume (Pal et al, 2018).…”

“…Appropriate attention to psycho-neuro-endocrinological problems may help clinicians develop a more reliable and holistic view of patients and improve the likelihood of delivering the most appropriate care (Ambad et al, 2020a). This highlights the need for more training to enhance early detection at this stage (Pal et al, 2018). Knowledge of the endocrine system and minerals are important for the proper treatment of psychiatric disorders (Ambad et al, 2020c,b).…”