THE INVENTORY TO DIAGNOSE DEPRESSION (IDD) IN PRIMARY-CARE PATIENTS

Major depressive disorder (MDD) is highly prevalent in ambulatory prim ary care patients. Severe functional impairment and risk of suicide ar e features of the condition. Although treatment can reduce morbidity, detection of MDD by primary care physicians is suboptimal. The aim of this study is to assess the inventory to diagnose depression (IDD) as compared with clinical psychiatric assessment for case finding in prim ary care patients. Adult members of an Israeli kibbutz (communal settl ement), where all psychiatric diagnoses made by the family physician a re confirmed by psychiatric consultation, were asked to complete the I DD; a 22 question, self-administered questionnaire. Patients whose sco res indicated MDD, if not previously diagnosed, were also referred to psychiatrists. Patients' medical charts were reviewed for the diagnosi s of MDD and response to therapy prior to the administration of the ID D. Of the sample of 312 patients, 207 (66.3%) completed the IDD. Refus ers were younger (P = 0.04), more likely to be native born Israelis (P = 0.02), and had a higher prevalence of known MDD (P = 0.05) than par ticipants. MDD by IDD scores was present in seven patients, in three o f whom the diagnosis had previously been established; the other four w ere newly diagnosed. In the three previously diagnosed patients, one ( metastatic carcinoma) refused treatment and two were receiving psychot herapy; all were clinically depressed. Four additional previously diag nosed patients whose IDD scores were insufficient for MDD had had a su ccessful response to current therapy. A full test of the validity of t he IDD as a diagnostic instrument as compared with clinical psychiatri c assessment as the criterion standard, requires concurrent assessment with both methods of all patients studied. Although patients with neg ative IDD scores did not receive psychiatric assessment, the diagnosis of MDD was confirmed by psychiatrists in all patients with positive s cores.