Katja Beesdo-Baum1,2,3, Susanne Knappe4, Franziska Einsle4, Lisa Knothe4,5, Gesine Wieder4,5, John Venz4,5,6, Christine Rummel-Kluge7,8, Ines Heinz9, Nicole Koburger10,8, Meryam Schouler-Ocak11, Theresia Wilbertz11, Hans-Peter Unger12, Ulrich Walter13, Joachim Hein14, Ulrich Hegerl7,9,8, Roselind Lieb15, Andrea Pfennig16, Jochen Schmitt17, Jürgen Hoyer4, Hans-Ulrich Wittchen4,6,18, Antje Bergmann19. 1. Institut für Klinische Psychologie und Psychotherapie, Behaviorale Epidemiologie & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Deutschland. Katja.Beesdo-Baum@tu-dresden.de. 2. Behaviorale Epidemiologie, Technische Universität Dresden, Dresden, Deutschland. Katja.Beesdo-Baum@tu-dresden.de. 3. Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Deutschland. Katja.Beesdo-Baum@tu-dresden.de. 4. Institut für Klinische Psychologie und Psychotherapie, Behaviorale Epidemiologie & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Deutschland. 5. Behaviorale Epidemiologie, Technische Universität Dresden, Dresden, Deutschland. 6. Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Deutschland. 7. Stiftung Deutsche Depressionshilfe, Leipzig, Deutschland. 8. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Deutschland. 9. Deutsches Bündnis gegen Depression e.V., Leipzig, Deutschland. 10. Leipziger Bündnis gegen Depression e.V., Leipzig, Deutschland. 11. Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Deutschland. 12. Harburger Bündnis gegen Depression e.V., Asklepios Klinik Harburg, Hamburg, Deutschland. 13. Akademie für Suizidprävention des Gesundheitsnetz Osthessen e.V., Fulda, Deutschland. 14. Münchner Bündnis gegen Depression e.V., München, Deutschland. 15. Klinische Psychologie und Epidemiologie, Fakultät für Psychologie, Universität Basel, Basel, Schweiz. 16. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Carl-Gustav Carus, Technische Universität Dresden, Dresden, Deutschland. 17. Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Medizinische Fakultät Carl-Gustav Carus, Technische Universität Dresden, Dresden, Deutschland. 18. Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, München, Deutschland. 19. Allgemeinmedizin, Medizinische Fakultät Carl-Gustav Carus, Technische Universität Dresden, Dresden, Deutschland.
Abstract
BACKGROUND: Primary care physicians (PCPs) play a crucial role for guideline-oriented intervention in patients with depression. OBJECTIVES: Based on a diagnostic screening questionnaire, this study investigates the sensitivity of PCPs to recognize patients with depression as well as the factors facilitating recognition and concordant diagnostic decisions. METHOD: In a cross-sectional epidemiological study in six regions of Germany, 3563 unselected patients filled in questionnaires on mental and physical complaints and were diagnostically evaluated by their PCP (N = 253). The patient reports on an established Depression-Screening-Questionnaire (DSQ), which allows the approximate derivation of an ICD-10 depression diagnosis, were compared with the physician diagnosis (N = 3211). In a subsample of discordant cases a comprehensive standardized clinical-diagnostic interview (DIA-X/CIDI) was applied. RESULTS: On the study day, the prevalence of ICD-10 depression was 14.3% according to the DSQ and 10.7% according to the physician diagnosis. Half of the patients identified by DSQ were diagnosed with depression by their physician and two thirds were recognized as mental disorder cases. More severe depression symptomatology and the persistent presence of main depression symptoms were related to better recognition and concordant diagnostic decisions. Diagnostic validation interviews confirmed the DSQ diagnosis in the majority of the false-negative cases. Indications for at least a previous history of depression were found in up to 70% of false-positive cases. CONCLUSION: Given the high prevalence of depression in primary care patients, there is continued need to improve the recognition and diagnosis of these patients to assure guideline-oriented treatment.
BACKGROUND: Primary care physicians (PCPs) play a crucial role for guideline-oriented intervention in patients with depression. OBJECTIVES: Based on a diagnostic screening questionnaire, this study investigates the sensitivity of PCPs to recognize patients with depression as well as the factors facilitating recognition and concordant diagnostic decisions. METHOD: In a cross-sectional epidemiological study in six regions of Germany, 3563 unselected patients filled in questionnaires on mental and physical complaints and were diagnostically evaluated by their PCP (N = 253). The patient reports on an established Depression-Screening-Questionnaire (DSQ), which allows the approximate derivation of an ICD-10 depression diagnosis, were compared with the physician diagnosis (N = 3211). In a subsample of discordant cases a comprehensive standardized clinical-diagnostic interview (DIA-X/CIDI) was applied. RESULTS: On the study day, the prevalence of ICD-10 depression was 14.3% according to the DSQ and 10.7% according to the physician diagnosis. Half of the patients identified by DSQ were diagnosed with depression by their physician and two thirds were recognized as mental disorder cases. More severe depression symptomatology and the persistent presence of main depression symptoms were related to better recognition and concordant diagnostic decisions. Diagnostic validation interviews confirmed the DSQ diagnosis in the majority of the false-negative cases. Indications for at least a previous history of depression were found in up to 70% of false-positive cases. CONCLUSION: Given the high prevalence of depression in primary care patients, there is continued need to improve the recognition and diagnosis of these patients to assure guideline-oriented treatment.
Entities:
Keywords:
Depression; Diagnosis; Prevalence; Primary care physician; Recognition