NONDETECTION OF DEPRESSION BY PRIMARY-CARE PHYSICIANS RECONSIDERED

This article examines the rates of detection for major depression and other depressive disorders by family physicians as well as the differe nces between detected and undetected cases in terms of a variety of de mographic and clinical variables. A total of 1,580 family practice pat ients completed a screening form and were rated by their physician. Pa tients with elevated Center for Epidemiologic Studies-Depression Scale (CES-D) scores were oversampled for possible interviews using the Str uctured Clinical Interview for DSM-III-R (SCID). In the resulting weig hted sample, family physicians detected 34.9% of cases of major depres sion and 27.9% of cases of any depressive disorder. Detection was asso ciated with pharmacological and psychological intervention. However, t he undetected cases tended to be mildly depressed and higher functioni ng. Presence of a current anxiety disorder facilitated detection. Over all, the mildness of undetected depression and associated impairment h ave implications for estimates of the consequences of primary care phy sicians' low rates of nondetection and for the development of interven tional strategies to improve their performance.