Recognition of depressive symptoms by physicians

Autor(es)

Henriques, Sergio Goncalves ^{[1, 2]} ; Fraguas, Renerio ^{[1, 2]} ; Iosifescu, Dan V. ^[3] ; Menezes, Paulo Rossi ^[4] ; Souza de Lucia, Mara Cristina ^[5] ; Gattaz, Wagner Farid ^{[1, 2]} ; Martins, Milton Arruda ^[6]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Fac Med, Dept Psychiat, Hosp Clin, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med, Inst Psychiat, Hosp Clin, Sao Paulo - Brazil

^[3] Harvard Univ, Massachusetts Gen Hosp, Depress Clin & Res Program, Boston, MA 02115 - USA

^[4] Univ Sao Paulo, Fac Med, Dept Prevent Med, Sao Paulo - Brazil

^[5] Univ Sao Paulo, Fac Med, Div Psychol, Hosp Clin, Sao Paulo - Brazil

^[6] Univ Sao Paulo, Fac Med, Dept Clin Med, Hosp Clin, Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: Clinics; v. 64, n. 7, p. 629-635, 2009.
• Citações Web of Science: 12
• Assunto(s): Medicina Atenção primária à saúde Ansiedade Depressão

Resumo

OBJECTIVE: To investigate the recognition of depressive symptoms of major depressive disorder (MDD) by general practitioners. INTRODUCTION: MDD is underdiagnosed in medical settings, possibly because of difficulties in the recognition of specific depressive symptoms. METHODS: A cross-sectional study of 316 outpatients at their first visit to a teaching general hospital. We evaluated the performance of 19 general practitioners using Primary Care Evaluation of Mental Disorders (PRIME-MD) to detect depressive symptoms and compared them to 11 psychiatrists using Structured Clinical Interview Axis I Disorders, Patient Version (SCID I/P). We measured likelihood ratios, sensitivity, specificity, and false positive and false negative frequencies. RESULTS: The lowest positive likelihood ratios were for psychomotor agitation/retardation (1.6) and fatigue (1.7), mostly because of a high rate of false positive results. The highest positive likelihood ratio was found for thoughts of suicide (8.5). The lowest sensitivity, 61.8%, was found for impaired concentration. The sensitivity for worthlessness or guilt in patients with medical illness was 67.2% (95% CI, 57.4-76.9%), which is significantly lower than that found in patients without medical illness, 91.3% (95% CI, 83.2-99.4%). DISCUSSION: Less adequately identified depressive symptoms were both psychological and somatic in nature. The presence of a medical illness may decrease the sensitivity of recognizing specific depressive symptoms. CONCLUSIONS: Programs for training physicians in the use of diagnostic tools should consider their performance in recognizing specific depressive symptoms. Such procedures could allow for the development of specific training to aid in the detection of the most misrecognized depressive symptoms. (AU)

• Processo FAPESP: 99/00669-9 - Utilizacao do prime-md por medicos nao psiquiatras para deteccao de depressao em ambulatorio de clinica medica.
• Beneficiário: Renério Fráguas Junior
• Modalidade de apoio: Auxílio à Pesquisa - Regular