THE RECOGNITION OF DEPRESSION IN PATIENTS REFERRED TO A CONSULTATION-LIAISON SERVICE

The recognition of depression was examined in 987 medical and surgical patients referred to a consultation-liaison psychiatry service. Overa ll concordance of recognition of depression by the referring doctor an d diagnosis of depression by the consultant psychiatrist was 74%; 41% false-positive rate, 15% false-negative rate. Concordance was higher i n the Renal Unit and lower in the General Medical Unit. Patients for w hom there was discordance were significantly older than those for whom there was concordance. Patients referred for depression but not diagn osed as such by psychiatrists received DSM-III-R diagnoses of Organic Mental Disorder, Somatoform and Related Disorders, Psychoactive Substa nce Use Disorders and Personality Disorders. On the other hand, patien ts diagnosed as having depression but not referred as such were referr ed instead for ill-defined reasons (suspected psychological component to illness, coping problems), suicide risk evaluation and routine pre- operative or pre-dialysis assessment. The results highlight the contin uing misdiagnosis of psychiatric disorders, especially Organic Mental Disorders, as well as the mislabelling of the syndrome described by ps ychiatrists as depression. This is part of the wider problem of defini ng the boundaries of a clinical depressive syndrome in the physically ill.