Accuracy of general practitioner unassisted detection of depression

Objective: Primary care is an important setting for the treatment of depression. The aim of the study was to describe the accuracy of unassisted general practitioner judgements of patients’ depression compared to a standardised depression-screening tool delivered via touch-screen computer. Method: English-speaking patients, aged 18 or older, completed the Patient Health Questionnaire-9 (PHQ-9) when presenting for care to one of 51 general practitioners in Australia. General practitioners were asked whether they thought the patients were clinically depressed. General practitioner judgements of depression status were compared to PHQ-9 results. Results: A total of 1558 patients participated. Twenty per cent of patients were identified by the PHQ-9 as being depressed. General practitioners estimated a similar prevalence; however, when compared to the PHQ-9, GP judgement had a sensitivity of 51% (95% CI [32%, 66%]) and a specificity of 87% (95% CI [78%, 93%]). Conclusions: General practitioner unassisted judgements of depression in their patients lacked sensitivity when compared to a standardised psychiatric measure used in general practice.

[1]  Anthony F Jorm,et al.  General practitioners' detection of depression and dementia in elderly patients , 1990, The Medical journal of Australia.

[2]  B. Rovner,et al.  The Epidemiology of Major Depressive Disorder , 2003 .

[3]  A. Mitchell,et al.  International comparison of clinicians' ability to identify depression in primary care: meta-analysis and meta-regression of predictors. , 2011, The British journal of general practice : the journal of the Royal College of General Practitioners.

[4]  J. Ayuso-Mateos,et al.  Reducing the global burden of depression , 2004, British Journal of Psychiatry.

[5]  C. Hewitt,et al.  Screening for Depression in Medical Settings with the Patient Health Questionnaire (PHQ): A Diagnostic Meta-Analysis , 2007, Journal of General Internal Medicine.

[6]  J. Slade.  The Mental health of Australians 2: report on the 2007 national survey of mental health and wellbeing , 2009 .

[7]  Simon Gilbody,et al.  Should we screen for depression? , 2006, BMJ : British Medical Journal.

[8]  Stanley E. Kaufman,et al.  Electronic collection of health-related quality of life data: Validity, time benefits, and patient preference , 2004, Quality of Life Research.

[9]  A. Mitchell,et al.  Clinical diagnosis of depression in primary care: a meta-analysis , 2009, The Lancet.

[10]  R. Goldberg.  Depression in primary care , 1988, Journal of General Internal Medicine.

[11]  W. Katon,et al.  Recovery from depression, work productivity, and health care costs among primary care patients. , 2000, General hospital psychiatry.

[12]  M. Hilton,et al.  The Association Between Mental Disorders and Productivity in Treated and Untreated Employees , 2009, Journal of occupational and environmental medicine.

[13]  D. O'Connor,et al.  Depression in Primary Care 2: General Practitioners' Recognition of Major Depression in Elderly Patients , 2001, International Psychogeriatrics.

[14]  Olga V. Demler,et al.  The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). , 2003, JAMA.

[15]  H. Brodaty,et al.  General practitioner diagnosis of depression and dementia in the elderly: can academic detailing make a difference? , 1994, Family practice.

[16]  E. Paykel,et al.  Unrecognised depression in general practice. , 1985, British medical journal.

[17]  G. Ramirez,et al.  Identifying depression in primary care: a literature synthesis of case-finding instruments. , 2002, General hospital psychiatry.

[18]  Prabjyot Kaur Chahil.  Reducing the Global Burden of Depression , 2014 .

[19]  Steven McGee,et al.  Simplifying likelihood ratios , 2002, Journal of General Internal Medicine.

[20]  A. Paraponaris,et al.  General Practitioners' Choices and Their Determinants When Starting Treatment for Major Depression: A Cross Sectional, Randomized Case-Vignette Survey , 2012, PloS one.

[21]  Ronald C Kessler,et al.  Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial. , 2007, JAMA.

[22]  D. Altman,et al.  Statistics Notes: Diagnostic tests 2: predictive values , 1994, BMJ.

[23]  G. Simon,et al.  Health care costs of primary care patients with recognized depression. , 1995, Archives of general psychiatry.

[24]  G. Andersson,et al.  Are psychological and pharmacologic interventions equally effective in the treatment of adult depressive disorders? A meta-analysis of comparative studies. , 2008, The Journal of clinical psychiatry.

[25]  R. Spitzer,et al.  The PHQ-9 , 2001, Journal of General Internal Medicine.

[26]  David R. Williams,et al.  Cross-national epidemiology of DSM-IV major depressive episode , 2011, BMC medicine.

[27]  R. Spitzer,et al.  Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. , 1999, JAMA.

[28]  R. Glasgow,et al.  Severity of Depression and Magnitude of Productivity Loss , 2011, The Annals of Family Medicine.

[29]  M. Phipps,et al.  Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement. , 2016, JAMA.

[30]  Hendrik van den Bussche,et al.  Does GP training in depression care affect patient outcome? - A systematic review and meta-analysis , 2012, BMC Health Services Research.

[31]  R. Sanson-Fisher,et al.  Touch screen computer health assessment in Australian general practice patients: a cross-sectional study protocol , 2012, BMJ Open.

[32]  A. Mitchell,et al.  Acceptability of common screening methods used to detect distress and related mood disorders—preferences of cancer specialists and non‐specialists , 2008, Psycho-oncology.

[33]  N. Summerton.  Making a diagnosis in primary care: symptoms and context. , 2004, The British journal of general practice : the journal of the Royal College of General Practitioners.

[34]  A. Tylee,et al.  The importance of somatic symptoms in depression in primary care. , 2005, Primary care companion to the Journal of clinical psychiatry.

[35]  J. Ockene,et al.  Screening for depression in adults: U.S. preventive services task force recommendation statement. , 2009, Annals of internal medicine.

[36]  J. Coyne,et al.  Do ultra-short screening instruments accurately detect depression in primary care? A pooled analysis and meta-analysis of 22 studies. , 2007, The British journal of general practice : the journal of the Royal College of General Practitioners.

[37]  I. Hickie,et al.  What can alert the general practitioner to people whose common mental health problems are unrecognised? , 2008, The Medical journal of Australia.

[38]  P. Henningsen,et al.  Depression, anxiety, and somatoform disorders: vague or distinct categories in primary care? Results from a large cross-sectional study. , 2009, Journal of psychosomatic research.

[39]  B. Penninx,et al.  Do GPs' medical records demonstrate a good recognition of depression? A new perspective on case extraction. , 2011, Journal of affective disorders.

[40]  A. Lacy,et al.  Postoperative surveillance in patients with colorectal cancer who have undergone curative resection: a prospective, multicenter, randomized, controlled trial. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[41]  I. Hickie,et al.  Unmet need for recognition of common mental disorders in Australian general practice , 2001, The Medical journal of Australia.

[42]  V. Starcevic,et al.  Diagnostic processes in mental health: GPs and psychiatrists reading from the same book but on a different page , 2012, Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists.

[43]  Michael J. Campbell,et al.  Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial , 2000, The Lancet.

[44]  J. Susman,et al.  Reinvention of Depression Instruments by Primary Care Clinicians , 2010, The Annals of Family Medicine.

[45]  P. Baume.  Australian Institute for Suicide Research and Prevention. , 1996, Collegian.

[46]  Anthony F Jorm,et al.  Who uses mental health services in Australia? An analysis of data from the National Survey of Mental Health and Wellbeing. , 2000, The Australian and New Zealand journal of psychiatry.

[47]  J. Coyne,et al.  False positives, false negatives, and the validity of the diagnosis of major depression in primary care. , 1998, Archives of family medicine.

[48]  Ronald C Kessler,et al.  The economic burden of depression in the United States: how did it change between 1990 and 2000? , 2003, The Journal of clinical psychiatry.