SHORT-TERM OUTCOMES OF DETECTED AND UNDETECTED DEPRESSED PRIMARY-CAREPATIENTS AND DEPRESSED PSYCHIATRIC-PATIENTS

The aims of this study were to determine wheather defection of major d epression in primary care was associated with improved outcome, and to compare the 4.5 month outcomes of detected and undetected depressed p rimary care patients and depressed psychiatric patients. Primary care patients with major depression were recruited from the practices of 50 family physicians in Southeastern Michigan using a two-stage selectio n procedure employing the Center for Epidemiologic Studies-Depression Scale (CES-D) and the Structured Clinical Interview for DSM-III-X (SCI D); clinician detection of depression teas ascertained by response to a direct query on a rating form. Depressed patients seeking treatment in an outpatient psychiatric setting also received the CES-D and the S CID. Data on patient demographics nl rd clinical characteristics were obtained for both primary care and psychiatric patients. Initial and 4 .5 month scores on the Hamilton Depression rating Scale (HAM-D) were o btained for 34 undetected and 25 detected depressed primary care and 5 5 depressed psychiatric patients. Improvement in depression over time was assessed by the change in HAM-D scores over the 4.5 months. The th ree groups did not differ in initial severity. Both psychiatric and un detected primary care patients showed significant improvement at 4.5 m onths, whereas detected primary care patients did not improve. At 4.5 months there were no differences in mean HAM-D scores between undetect ed, depressed primary care patients and depressed psychiatric outpatie nts. This result did not change after controlling for age and severity of depression at initial presentation, nor did it change after exclus ion of cases of mild depression to control for a possible ''floor effe ct.'' However, differences among groups in the stage of depressive epi sodes may have affected this comparison. These findings suggest that a n exclusive focus on increasing detection of depression in primary car e patients is unlikely to improve outcomes, and that undetected depres sion among primary care patients does not necessarily represent poor q uality of care. Although depressed psychiatric patients in this study had better outcomes than detected depressed primary care patients, the presence of unmeasured differences among groups in the stage of the d epressive episode makes it impossible to determine whether treatment o f depression by psychiatrists is superior to that provided by primary care physicians. These findings should stimulate efforts to examine a more comprehensive model for detection and treatment of depression in primary care. (C) 1997 Elsevier Science Inc.