PATIENT PRESENTATION, INTERVIEW CONTENT, AND THE DETECTION OF DEPRESSION BY PRIMARY-CARE PHYSICIANS

This study was undertaken in order to better understand the detection of depression by primary care physicians. Specifically, we investigate d the relationship between information gathered during the course of t he medical interview and the subsequent diagnosis of depression. Forty -seven community-based primary care physicians, unaware of the mental health focus of this research, were videotaped in the office setting, as they interviewed two ''typical'' standardized patients who met DSM- III-R criteria for major depression. One patient presented with headac hes and the other presented with palpitations and chest pain. After ea ch interview, physicians were provided with physical findings and resu lts of any diagnostic procedures they ordered, then asked to construct and explicate their differential diagnoses. The two patients were cor rectly diagnosed as depressed by 53 and 45% of the physicians. Althoug h detection was related to greater amounts of information gathered, in quiry about the DSM-III-R criteria symptoms was generally low, and in no case was sufficient information acquired to make a formal DSM-III-R diagnosis of depression. However, a subset of the DSM-III-R symptoms (those related to disturbances of appetite, sleep, and other neurovege tative functions) were among the reasons cited for inclusion of depres sion in the differential, as were psychosocial stressors and the patie nt's appearance. These findings suggest that detection of depression i s low by primary care physicians.