The effect of patient and visit characteristics on diagnosis of depression in primary care.

OBJECTIVES: The purpose of our study was to determine if factors other than the patient' clinical presentation were associated with the likelihood of depression being recognized during a physician office visit. STUDY
DESIGN: We used a cross-sectional design. POPULATION: Data from the 1997 and 1998 National Ambulatory Medical Care Surveys were examined. OUTCOMES MEASURED: We assessed the association of factors such as age, sex, race, physician specialty, type of insurance, and visit duration with a recorded depression diagnosis during office visits to primary care physicians.
RESULTS: After controlling for symptom presentation, primary care physicians were 56% less likely to record a diagnosis of depression during visits made by elderly patients, 37% less likely to do so during visits by African Americans, and 35% less likely to do so during visits by Medicaid patients. Visits with a depression diagnosis were, on average, 2.9 minutes longer in duration (16.4 vs 19.3) than visits without a depression diagnosis. Family practice and general practice physicians were 65% more likely to record a diagnosis of depression than internists.
CONCLUSIONS: Many factors were associated with making and recording a depression diagnosis beyond the patient' reported symptoms. If rates of diagnosis are to improve, interventions that go beyond getting physicians to recognize the symptoms of depression are needed.