A. Niro Siriwardena, MBBS, MMedSci, PhD
How accurate are nonpsychiatric physicians in recognizing depression in their patients?
Studies selected evaluated the accuracy of nonpsychiatric physicians in recognizing depression in adult patients who attended primary care facilities, emergency departments, or outpatient clinics or were admitted to hospital. “Recognition” was ascertained directly by an explicit statement or rating of depression by the physician (physician diagnosis method) or indirectly by chart review indicating antidepressant medication prescription, referral to a mental health specialist, or identification of depressive symptoms (chart review method). The reference standard for depression was diagnosis by a psychiatrist or by research staff using a structured clinical interview or rating scale with a specified cutpoint. Outcomes were summary sensitivity, specificity, and diagnostic odds ratio.
MEDLINE, EMBASE/Excerpta Medica, CINAHL, and PsycINFO (to 2006); and reference lists were searched for studies published in English or French. 36 studies (n = 59 978) with 39 comparisons met the selection criteria. 69% of studies explicitly stated that the nonpsychiatric physician was blinded to the depression diagnosis.
Summary diagnostic characteristics are shown in the Table. Sensitivity was higher in studies that used the physician-diagnosis method than in those that used the chart-review method (Table). Sensitivity was lower in studies involving only patients ≥ 55 years of age than in those involving all ages (Table).
Nonpsychiatric physicians have low accuracy for recognizing depression in their patients.
Accuracy of nonpsychiatric physicians in recognizing depression in their patients compared with diagnosis by a psychiatrist or validated rating scale*
*Diagnostic terms and CI defined in Glossary.
†See text for explanation.
Siriwardena AN. Review: Nonpsychiatric physicians have low accuracy for recognizing depression. Ann Intern Med. ;148:JC4–11. doi: 10.7326/0003-4819-148-12-200806170-02011
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Published: Ann Intern Med. 2008;148(12):JC4-11.
Emergency Medicine, Hospital Medicine.
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