Internal medical residents' ability to diagnose and characterize major depression

The purpose of this study was to assess medical residents' knowledge of sym ptom criteria and subtypes of major depressive episode and their accuracy i n diagnosing major depressive disorders and classifying episode severity an d subtype according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Thirty-five third-year internal medicine residents completed a self-administered, written instrument containing 2 o pen-ended questions and 21 hypothetical scenarios. The sensitivity for reco gnizing major depressive disorder was 64%, and the specificity was 69%. The sensitivity for classifying severity was 86% for mild, 66% for moderate, 7 1% for severe, and 66% for severe with psychosis. Misclassification of seve rity was most commonly to a less severe class. For scenarios with a diagnos able subtype of a major depressive disorder, the sensitivity for classifica tion was 34% for atypical, 51% for catatonic, 74% for melancholic, 100% for postpartum, and 94% for seasonal depression. When asked to enumerate the c riteria symptoms for depression, 80% or more of the residents listed sad mo od, loss of interest, weight change, and sleep disturbances; 14 to 21 (40%- 60%) listed thoughts of death and worthlessness; other criteria were listed by 7 to 11 (20%-31%). When asked to list the episode subtypes, none was li sted by more than 3 (9%) residents, although 13 (37%) residents volunteered psychotic as a subtype. Residents frequently failed to recognize the prese nce or absence of major depressive disorder and often misclassified episode severity and subtype on scenarios. Few could spontaneously list the episod e subtypes. Methods must be developed to improve the recognition and classi fication of major depressive episodes to better direct treatment.