Six-month outcomes for medical patients with major depressive disorders.

The courses of depressive disorders and factors affecting recovery rates among patients treated in primary medical care facilities have rarely been studied. The authors investigated the clinical status of 274 patients initially and six months after they sought care at one of three primary care sites. Through use of the highly structured Diagnostic Interview Schedule, they found that physicians assigned a depressive diagnosis to only a fourth of the patients so assessed by the structured interview. Nevertheless, the rates of persisting major depressive disorders at follow-up were found to be very similar for patients whom both the structured interview and the physician initially considered depressed and those so diagnosed by structured interview but not by the physician (25% and 31%, respectively). An analysis of factors associated with course of illness suggests that psychiatric status at the initial assessment and the number of assigned medical diagnoses rather than the physician's recognition and treatment of depression strongly predict continued affective disorder.