Primary Care Research

Primary care doctors miss diagnosing two-thirds of people suffering from depression

Up to one in four primary care patients suffer from depression; yet, primary care doctors identify only one-third (31 percent) of these patients. They are slightly more likely to diagnose depression (38 percent of depressed patients) among patients with suicidal thoughts or who sleep all the time (hypersomnia) or can't sleep (insomnia), according to a new study.

Routine screening of primary care patients for this problem may improve the number of depressed patients who are diagnosed by their doctors, suggest the California researchers. They examined depression diagnosis among 304 primary care patients (mostly Latinos and blacks), who screened positive for depression at 2 large primary care practices. Of these patients, 75 percent were significantly depressed, and 58 percent had both significant depression symptoms and functional impairment (such as insomnia). Suicidal thoughts increased 5.4-fold the likelihood of physician diagnosis of depression, and hypersomnia or insomnia doubled the likelihood of diagnosis.

Other depression symptoms (for example, fatigue, poor appetite or overeating, excessive guilt, inability to concentrate, and agitation) and chronic medical conditions, such as high blood pressure and diabetes, had no effect on physician diagnosis of depression. Nevertheless, there was little agreement between patients' initial structured depression assessments and physicians' appraisal of depression symptoms during the clinical visit (either elicited or documented in the patient's chart).

The authors call for more studies to explore how physicians assess depression symptoms. The study was supported in part by the Agency for Healthcare Research and Quality (HS14022).

More details are in "Depression symptomatology and diagnosis: Discordance between patients and physicians in primary care settings," by Chizobam Ani, M.B.B.S., M.P.H., Mohsen Bazargan, Ph.D., David Hindman, Ph.D., and others, in the 2008 BMC Family Practice 9(1), available online at www.biomedcentral.com.

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