HOW DOES THE CONTENT OF CONSULTATIONS AFFECT THE RECOGNITION BY GENERAL-PRACTITIONERS OF MAJOR DEPRESSION IN WOMEN

Background. Major depression is a common and disabling condition. Howe ver, for many reasons, the condition is not recognized in about half o f the patients with major depression. Aim. The aim of the study was to establish whether the content of general practice consultations affec ted general practitioners' recognition of major depressive illness in women patients. Method. The 30-item general health questionnaire was u sed as a first stage screening instrument for psychiatric morbidity. P atients newly recognized as depressed by their general practitioner an d those not recognized as depressed who scored 11 or more on the quest ionnaire were interviewed, usually within three days of consulting the ir general practitioner, using the combined psychiatric interview Vide orecordings of the consultations for these two groups of women were an alysed; analyses were based on mentions of physical, psychiatric and s ocial symptoms and on whether the first mention of a psychiatric sympt om was within the first four mentions of any symptoms (early in the co nsultation) or after four mentions of any symptoms (late) or if psychi atric symptoms were not mentioned. Results. A paired sample of 72 wome n with major depression was obtained from patients consulting 36 gener al practitioners, each general practitioner providing one patient whom he or she had correctly recognized as being depressed and one patient whose depression had not been recognized. Women with major depression were about five times more likely to have their depression recognized if they mentioned their psychiatric symptoms early in the consultatio n compared with those who either left it later to mention such symptom s or never mentioned them. Major depression was more likely to be reco gnized if no physical illness was present. After adjusting for physica l illness, depression was 10 times less likely to be recognized if the first psychiatric symptom was mentioned late in the consultation, or not mentioned at all, than if it was mentioned early in the consultati on. Conclusion. General practitioners need to remember that patients w ho present with symptoms of physical illness may also have depression. They also need to remember to give equal importance diagnostically to mentions of symptoms at whatever point they occur in the consultation , regardless of the presence or absence of physical illness.