RECOGNITION AND TREATMENT OF DEPRESSIVE-DISORDERS BY INTERNAL-MEDICINE ATTENDINGS AND HOUSESTAFF

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.