IDENTIFICATION OF DEPRESSION IN A RURAL GENERAL-PRACTICE

Major depression is underdiagnosed by general practitioners, but the r easons for this are not clear. This study aimed to establish the preva lence of major depression and coexisting generalised anxiety disorder in a rural general practice in the Orange Free State. It also assessed the predictive value of a screening questionnaire for use by general practitioners. The two practitioners evaluated 858 patients over a 4-w eek period, Those who met the screening criteria, together with a rand om sample of 60 patients who did not, were re-evaluated by a registrar in psychiatry who was unaware of the findings of his colleagues. Of t he patients studied, 134 (15,6%) had major depression; 59 of these (44 ,0%) also had coexisting generalised anxiety disorder. The general pra ctitioners had correctly diagnosed major depression in 32 patients (3, 7%) before the study started. The screening questionnaire had a 42% ch ance of correctly identifying a patient with depression and a 97% chan ce of correctly identifying a patient who did not have major depressio n. Both practitioners were equally capable at identifying major depres sion. The study confirmed both the high prevalence of depression in a rural general practice and its low identification rate. It also showed the advantage of using a screening questionnaire to alert practitione rs to the possibility of depression in their patients.