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Recognition of depressive symptoms by physicians

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Autor(a) principal: Henriques, Sergio Gonçalves
Data de Publicação: 2009
Outros Autores: Fráguas, Renério, Iosifescu, Dan V., Menezes, Paulo Rossi, Lucia, Mara Cristina Souza de, Gattaz, Wagner Farid, Martins, Milton Arruda
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Clinics
Texto Completo: https://www.revistas.usp.br/clinics/article/view/17885
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.
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spelling Recognition of depressive symptoms by physicians Internal medicineAmbulatory careDiagnosisDepressive disorderPrimary care 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. Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo2009-01-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://www.revistas.usp.br/clinics/article/view/1788510.1590/S1807-59322009000700004Clinics; Vol. 64 No. 7 (2009); 629-635 Clinics; v. 64 n. 7 (2009); 629-635 Clinics; Vol. 64 Núm. 7 (2009); 629-635 1980-53221807-5932reponame:Clinicsinstname:Universidade de São Paulo (USP)instacron:USPenghttps://www.revistas.usp.br/clinics/article/view/17885/19950Henriques, Sergio GonçalvesFráguas, RenérioIosifescu, Dan V.Menezes, Paulo RossiLucia, Mara Cristina Souza deGattaz, Wagner FaridMartins, Milton Arrudainfo:eu-repo/semantics/openAccess2012-05-22T18:41:52Zoai:revistas.usp.br:article/17885Revistahttps://www.revistas.usp.br/clinicsPUBhttps://www.revistas.usp.br/clinics/oai||clinics@hc.fm.usp.br1980-53221807-5932opendoar:2012-05-22T18:41:52Clinics - Universidade de São Paulo (USP)false
dc.title.none.fl_str_mv Recognition of depressive symptoms by physicians
title Recognition of depressive symptoms by physicians
spellingShingle Recognition of depressive symptoms by physicians
Henriques, Sergio Gonçalves
Internal medicine
Ambulatory care
Diagnosis
Depressive disorder
Primary care
title_short Recognition of depressive symptoms by physicians
title_full Recognition of depressive symptoms by physicians
title_fullStr Recognition of depressive symptoms by physicians
title_full_unstemmed Recognition of depressive symptoms by physicians
title_sort Recognition of depressive symptoms by physicians
author Henriques, Sergio Gonçalves
author_facet Henriques, Sergio Gonçalves
Fráguas, Renério
Iosifescu, Dan V.
Menezes, Paulo Rossi
Lucia, Mara Cristina Souza de
Gattaz, Wagner Farid
Martins, Milton Arruda
author_role author
author2 Fráguas, Renério
Iosifescu, Dan V.
Menezes, Paulo Rossi
Lucia, Mara Cristina Souza de
Gattaz, Wagner Farid
Martins, Milton Arruda
author2_role author
author
author
author
author
author
dc.contributor.author.fl_str_mv Henriques, Sergio Gonçalves
Fráguas, Renério
Iosifescu, Dan V.
Menezes, Paulo Rossi
Lucia, Mara Cristina Souza de
Gattaz, Wagner Farid
Martins, Milton Arruda
dc.subject.por.fl_str_mv Internal medicine
Ambulatory care
Diagnosis
Depressive disorder
Primary care
topic Internal medicine
Ambulatory care
Diagnosis
Depressive disorder
Primary care
description 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.
publishDate 2009
dc.date.none.fl_str_mv 2009-01-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv https://www.revistas.usp.br/clinics/article/view/17885
10.1590/S1807-59322009000700004
url https://www.revistas.usp.br/clinics/article/view/17885
identifier_str_mv 10.1590/S1807-59322009000700004
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv https://www.revistas.usp.br/clinics/article/view/17885/19950
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
publisher.none.fl_str_mv Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
dc.source.none.fl_str_mv Clinics; Vol. 64 No. 7 (2009); 629-635
Clinics; v. 64 n. 7 (2009); 629-635
Clinics; Vol. 64 Núm. 7 (2009); 629-635
1980-5322
1807-5932
reponame:Clinics
instname:Universidade de São Paulo (USP)
instacron:USP
instname_str Universidade de São Paulo (USP)
instacron_str USP
institution USP
reponame_str Clinics
collection Clinics
repository.name.fl_str_mv Clinics - Universidade de São Paulo (USP)
repository.mail.fl_str_mv ||clinics@hc.fm.usp.br
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