Diagnosing depression among new patients in ambulatory training settings.

A research-validated instrument, based upon the Diagnostic and Statistical Manual of Mental Disorders-III, is used as a "gold standard" to compare physician assessments of depression. Twenty-seven of 294 patients (9.2 percent) presenting to three primary care clinics for the first time met clinical criteria for a depressive disorder. Although the 27 depressed patients differed from the nondepressed patients on sociodemographic characteristics, prior service utilization patterns, and clinical variables, only 7 of the 27 were diagnosed as depressed by their primary care physicians. Factors associated with accurate assessment include comment in the patient's chart of a prior psychiatric history. Many depressed patients reporting high levels of dysphoria on a screening instrument had no mood symptoms recorded on their charts.