OVERDIAGNOSIS OF DEPRESSION IN THE GENERAL-HOSPITAL

To test the hypothesis that depression is often inaccurately detected in medical settings, we examined the psychiatric consultations perform ed at two medical-surgical teaching hospitals. All records for the 439 6 consultations seen in a 3-year period were retrospectively reviewed. Consultations were categorized by the reason for referral. These reas ons were compared with the consulting psychiatrist's diagnosis. Diagno ses were grouped into ''Depressed'' and ''Not Depressed'' categories, depending on whether the psychiatric diagnoses implied any form of dep ressive illness (alone or in combination with other diagnoses). The ma jority of the referrals for psychiatric consultation (about 25% and 30 % at the respective sites) were for presumed depression. Of these refe rrals for depression, approximately 40% were judged by the consultant to have no depressive diagnosis. Of the referrals for depression judge d not to be depressed, the majority had other undiagnosed illnesses, p articularly delirium, dementia, and anxiety disorders. The authors con clude that although numerous studies report that depression is unrecog nized in medical patients, it may also be inappropriately suspected. T his is of most concern when the presumption of depression delays other medical, neurological, ol psychiatric evaluation.