Dimensional perspective on the recognition of depressive symptoms in primary care - The Hampshire Depression Project 3

Background Most studies of the recognition of depression in primary care ha ve used a categorical definition of depression. This may overstate the exte nt of the problem. Aims Our objective was to investigate the relationship between severity and recognition of depression, and its modification by patient and practitione r characteristics. Method An association study in multiple consecutive adult cohorts of 18 414 primary care consultations drawn from a representative sample of 156 gener al practitioners in Hampshire, UK. Results There was a curvilinear relationship between the severity of depres sion and practitioners' ratings of depression. One case of probable depress ion was missed in every 28.6 consultations. Anxiety and unemployment altere d the chances of recognition, but age, gender and deprivation scores did no t. Conclusions A dimensional approach to severity of depression shows that gen eral practitioners may be better able to recognise depression than previous categorical studies have suggested. Efforts to improve the care of depress ion should therefore focus on doctors who have been shown to have difficult y making the diagnosis and on improving the treatment of identified patient s.