Under-diagnosis of alcohol-related problems and depression in a family practice in Japan

Abstract

AimThe aim of this survey was to assess the accuracy of a family physician's diagnosis of depression and alcoholism.MethodsConsecutive new adult patients attending a family practice in Japan between April 2004 and August 2006 were enrolled. Excluded were those with dementia or visual disturbance, and emergency cases. Participants completed a questionnaire regarding their complaints and socio-demographics. A research nurse conducted the Japanese version of the Mini-International Neuropsychiatric Interview (J-MINI) in the interview room. The doctor independently performed usual practice and recorded his own clinical diagnoses. A researcher listed the clinical diagnoses and complaints, including J-MINI or clinically-diagnosed alcoholism and depression, using the International Classifications for Primary Care, Second Edition (ICPC-2) and calculated kappa statistics between the J-MINI and clinical diagnoses.ResultsOf the 120 adult first-visit patients attending the clinics, 112 patients consented to participate in the survey and were enrolled. Fifty-one subjects were male and 61 female, and the average age was 40.7 ± 13.2 years. Eight alcohol-related disorders and five major depressions were diagnosed using the J-MINI, whereas no cases of alcoholism and eight depressions were diagnosed by the physician. Clinically overlooked patients tended to have acute illnesses like a common cold. Concordance between the clinical and research diagnosis was achieved only for three episodes of Major depression, resulting in a kappa statistic of 0.43.ConclusionAlthough almost half of the major depressions were identified, all alcoholism was missed. A mental health screening instrument might be beneficial in family practice, especially to detect alcoholism.

Psychiatric diagnosis in the elderly referred to a consultation‐liaison psychiatry service in a general geriatric hospital in Japan

“…19 In a study in Japan, almost half of the cases of major depression were identified using the Mini-International Neuropsychiatric Interview (MINI) in a family practice in Japan (kappa 0.43), but all the cases of alcoholism were missed. 20 The referring doctors in the present survey had an insufficient level of diagnostic accuracy for psychiatric disorders. Some psychotropic medications might be prescribed inappropriately to elderly patients with delirium or depression as a result of the lack of an accurate psychiatric diagnosis.…”

“…When the Structured Clinical Interview for DSM‐III‐R (SCID) was used, the kappa statistics estimated among mental health professionals within the same hospital were 0.76 for alcohol‐related disorder, 0.42 for current major depression and 0.65 for panic disorder among non‐psychiatric patients 19 . In a study in Japan, almost half of the cases of major depression were identified using the Mini‐International Neuropsychiatric Interview (MINI) in a family practice in Japan (kappa 0.43), but all the cases of alcoholism were missed 20 …”

Increased self‐transcendence in patients with intractable diseases

“…The J‐MINI was used to divide participants into two groups: MDE group (MDE is diagnosed if five or more of the nine items are present) and non‐MDE group (MDE is not diagnosed if less than five items are present). Major studies using the J‐MINI have been performed on psychiatric patients 38 and outpatients 39–41 …”

“…Major studies using the J-MINI have been performed on psychiatric patients 38 and outpatients. [39][40][41] Procedures Before we collected data in an institution, we received the approval from the person who is in charge of the institution. The researchers conducted the surveys after the informed consent was obtained from all participants.…”

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

“…A meta-analysis of the validity and reliability of the PHQ-9 as a screening tool at various cutoff points concluded that at a cut-off of 10, the PHQ-9 has a pooled sensitivity of 0.78 and specificity of 0.87, which is adequate [14]. In primary care, the best cut-off for detecting depression using the PHQ-9 was estimated at 11, with a sensitivity of 0.76 and specificity of 0.81 [15]. Taking these into consideration, along with the DSM-5 criteria for diagnosis of depression where 5 out of 9 symptoms are required, we considered a cut-off of 9 in this study (taking a positive score of ≥2 on all questions other than question 9, where a score ≥1 was considered positive, thus making a total score of 8+1 as the cut-off).…”