Why do general practitioners recognize major depression in one woman patient yet miss it in another?

The aim of this study was to establish whether psychiatric patient characteristics and the presence of physical illness affected general practitioners' recognition of major depressive illness in women patients. The 30-item general health questionnaire was used as a first stage screening instrument for psychiatric morbidity and each patient selected was interviewed, usually within three days of consulting their general practitioner, using the combined clinical interview. A sample of 72 women with major depressive disorder was obtained from patients consulting 36 general practitioners mainly from the south west Thames region of England, each general practitioner providing one patient he or she had correctly recognized as being depressed and one patient whose depression had not been recognized. Few differences were found between the groups with recognized and unrecognized depression in their psychiatric or physical features. More patients with unrecognized depression experienced physical illness and were tired. Patients with serious physical disease were five times more likely not to be recognized as depressed than those without physical disease. Patients with recognized depression described a more distinct quality to their depressed mood. Women with unrecognized major depression are similar to those women whose major depression is recognized by their general practitioner. These findings require further elaboration by process and content analysis of the women's consultations.