Jv. Penn et al., RECOGNITION AND TREATMENT OF DEPRESSIVE-DISORDERS BY INTERNAL-MEDICINE ATTENDINGS AND HOUSESTAFF, General hospital psychiatry, 19(3), 1997, pp. 179-184
Depression is underdiagnosed and undertreated by nonpsychiatric practi
tioners. Research suggests improvement is needed in the recognition an
d treatment of depressive disorders by primary care physicians. This s
tudy was undertaken to better understand internists' ability to recogn
ize depressive disorders, choice of appropriate medications, dosage, a
nd treatment patterns. Questionnaires were distributed to 45 internal
medicine attendings, 45 internal medicine housestaff, and 32 adult psy
chiatry residents. Each questionnaire contained four vignettes: major
depressive disorder (MDD), MDD with melancholic features, MDD with aty
pical features, and MDD with psychotic features. Eleven questions per
case covered diagnoses, management, and treatment. Data analysis with
intragroup comparisons on 20 internal medicine attendings, 33 internal
medicine housestaff, and 32 psychiatry residents suggested that many
internal medicine attendings and housestaff had difficulty in recogniz
ing major depression and its subtypes. Although the findings indicated
that internists would initiate pharmacological treatment, they freque
ntly made incorrect or questionable pharmacological choices. Psychiatr
ic referral or consultation was often endorsed. Our findings among int
ernists are consistent with previous research examining other primary
care physicians suggesting that depression is underdiagnosed and under
treated. (C) 1997 by Elsevier Science Inc.