Depression in primary care 2: General practitioners' recognition of major depression in elderly patients

Background: It is important that serious depressive illness be recognized a nd treated appropriately by primary care practitioners. This and the preced ing article in this issue examine (a) factors responsible for older patient s' decision to report depressive symptoms to their doctor and (b) general p ractitioners' (GPs') recognition of depression when it was present. Methods : A survey was conducted of a stratified sample of 1,021 patients aged 70years of 30 GPs in Melbourne, Australia, using the Canberra Interview for t he Elderly, which generates rigorous ICD-10 research diagnoses. Results: GP s' ratings of depression were best predicted in descending order of importa nce by patients' past contact with a psychiatrist, the doctor's view that a patient did not have dementia, the number of current depressive symptoms, patients' disclosure of these symptoms, and current physical pain. Physicia ns' assessments of patients' mood concurred with research diagnoses in 23 o f 35 (66%) cases of ICD-10 mild depressive episode and 23 of 26 (88%) cases of moderate or severe depressive episode. GPs were unaware, however, of ma ny depressive symptoms and often rated patients as being depressed when the y were not. Conclusion: The use of a simple checklist of depressive symptom s would lead to a dramatic improvement in doctors' knowledge of patients' c urrent psychiatric status.