Psychiatric caseness is a marker of major depressive episode in general practice

Objective

Screening for a major depressive episode (MDE) in high-risk groups of patients within the primary care setting has been suggested by several Central Health Organizations. The objective of this study was to investigate whether patients rated as “psychiatric cases” by their general practitioner (GP) were likely to suffer from MDE and therefore qualified for systematic diagnostic screening.

Design

Cross-sectional survey of primary care patients assessed through depression screening questionnaires and GP consultations.

Setting

A total of 676 general practices in Denmark, Finland, Norway, and Sweden.

Subjects

A total of 8879 unselected primary care patients.

Main outcome measures

Sensitivity, specificity, and Youden Index of the GPs'' diagnoses of depression and psychiatric caseness versus patients'' MDE status.

Results

The proportion of primary care patients receiving a false-positive diagnosis of depression by their GP ranged from 12.4% to 25.2% depending on country. The corresponding numbers for the false-negative diagnoses were 0.5–2.5%. Among patients with MDE, GPs recognize the disease in 56–75% of cases. However, GPs recognize as many as 79–92% of patients with MDE as “psychiatric cases”.

Conclusions

This report confirms that misclassifications of MDE are common in the primary care setting. In addition, it shows that psychiatric caseness is a valid marker for the presence of MDE in primary care patients. This relationship should be considered in future screening recommendations.Key Words: Depression, diagnosis, family practice, mass screening, questionnairesPatients with a major depressive episode (MDE) are often overlooked in the primary care setting. Central Health Organizations suggest screening for MDE in high-risk categories of primary care patients. This study investigated whether patients rated as “psychiatric cases” by their GPs were likely to suffer from MDE and therefore qualified for systematic diagnostic screening.

• Misclassifications of MDE were common in the present sample of primary care patients.
• Among primary care patients with MDE, general practitioners (GPs) recognized the disease in 56–75% of the cases.
• Up to 92% of patients with MDE were identified as psychiatric cases by their GP. This relationship should be considered in future screening recommendations.

Major depressive episode (MDE) is the most common mental disorder in primary care 1]. General practitioners (GPs) play a crucial role in detecting and treating mental disorders, including MDE 2]. Diagnosis and treatment of MDE in primary care remains a difficult challenge for GPs and misclassifications are common. There are two types of misclassifications of MDE, namely false negative (patients meeting MDE criteria, but who are not recognized as depressed by their GPs) and false positive (perceived to suffer from MDE by the GPs without fulfilling the MDE criteria) 3–7]. These misclassifications have obvious adverse effects for the patients and procedures to minimize their likelihood of occurrence are required. The purpose of this study was to examine the GPs'' diagnostic capability in relation to MDE and to evaluate whether patients rated as “psychiatric cases” by their GP were likely to suffer from MDE.