DIFFERENCES BETWEEN DETECTED AND UNDETECTED PATIENTS IN PRIMARY-CARE AND DEPRESSED PSYCHIATRIC-PATIENTS

The aim of this study was to explore differences between primary care and tertiary psychiatry patients meeting DSM-III-R criteria for depres sive disorders in terms of a wide range of demographic and clinical va riables including psychiatric comorbidity. A weighted sample of 153 de pressed primary care patients was obtained from the waiting rooms of f amily physicians using a two-stage selection and assessment procedure including the Structured Clinical Interview for the DSM-III-R (SCID). A measure of physician detection was also obtained. The 123 depressed psychiatric patients were seeking evaluation and treatment at a univer sity-based depression program, and DSM-III-X diagnoses were also obtai ned using the SCID. Overall, fewer depressed primary care patients met criteria for major depressive disorder, and more of those who did wer e only mildly depressed. Depressed primary cave patients were move lik ely to be women, older, and had less education, less past treatment, a nd greater lifetime comorbidity. Clinical differences were greatest fo r the depressed patients who had gone undetected by their physicians: they were higher functioning, less distressed, and more mildly depress ed. Findings are discussed in terms of the validity and acceptability of practice guidelines for depression in primary care. (C) 1996 Elsevi er Science Inc.