PHYSICIAN CHARACTERISTICS AND THE RECOGNITION OF DEPRESSION AND ANXIETY IN PRIMARY-CARE

We examined physician characteristics associated with the recognition of depression and anxiety in primary care. Fifty-five physicians treat ing a total of 600 patients completed measures of psychosocial orienta tion, psychological mindedness, self-rating of sensitivity to hidden e motions, and a video test of sensitivity to nonverbal communication. P atients were classified as cases of psychiatric distress based on the CES-D scale and the Diagnostic Interview Schedule. Physician recogniti on was determined by notation of any psychosocial diagnosis in the med ical charts over the ensuing 12 months. Of 192 patients scoring 16 or above on the CES-D, 44% (83) were recognized as psychiatrically distre ssed. Three findings were central to this study: 1) Physicians who are more sensitive to nonverbal expressions of emotion made more psychiat ric or psychosocial assessment of their patients and appeared to be ov er-inclusive in their judgments of psychosocial problems; 2) Physician s who tended to blame depressed patients for causing, exaggerating, or prolonging their depression made fewer psychosocial assessments and w ere less accurate in detecting psychiatric distress; 3) False positive labeling of patients who had no evidence of psychiatric distress was rare. Surprisingly, more severe medical illness increased the likeliho od of labeling and accurate recognition. Physician factors that increa sed recognition may indicate a greater willingness to formulate a psyc hiatric diagnosis and an ability notice nonverbal signs of distress.