Discovering Depression in Medical Patients: Reasonable Expectations

Editorials15 March 1997Discovering Depression in Medical Patients: Reasonable ExpectationsKurt Kroenke, MDKurt Kroenke, MDUniformed Services University of the Health Sciences, Bethesda, MD 20814Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-126-6-199703150-00008 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail One fact has been cited almost tiresomely: Primary care clinicians fail to diagnose depression in half of their patients who have the condition. When depression is detected, clinicians provide adequate treatment only half of the time 1-4. Because 5% to 10% of medical outpatients (and even more inpatients) have major depression, this indictment is alarming. However, it is also a bit too facile. It ignores the barriers that make detection of depression particularly challenging in the medical setting: time, somatization, stigmatization, reimbursement, and comorbid medical conditions.Most medical outpatient visits last 15 minutes or less 5, whereas visits to a ...References1. Perez-Stable EJ, Miranda J, Munoz RF, Ying YW. Depression in medical outpatients. Underrecognition and misdiagnosis. Arch Intern Med. 1990; 150:1083-8. Google Scholar2. Simon GE, VonKorff M. Recognition, management, and outcomes of depression in primary care. Arch Fam Med. 1995; 4:99-105. Google Scholar3. Miranda J, Hohmann AA, Attkisson CC, Larson DB, eds. Mental Disorders in Primary Care. San Francisco: Jossey-Bass; 1994. Google Scholar4. Depression Guideline Panel. Depression in Primary Care. Clinical Practice Guideline, no 5. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; April 1993. AHCPR publication no. 93-0551. Google Scholar5. Schappert SM. National Ambulatory Medical Care Survey: 1989 summary. Vital Health Stat. 1992; 13:1-80. Google Scholar6. Schappert SM. Office visits to psychiatrists: United States, 1989-90. Advance Data from Vital and Health Statistics, no. 237. Hyattsville, MD: National Center for Health Statistics; 1993. Google Scholar7. Katon W, Kleinman A, Rosen G. Depression and somatization: a review. Part I. Am J Med. 1982; 72:127-35. Google Scholar8. Spitzer RL, Williams JB, Kroenke K, Linzer M, DeGruy FV 3d, Hahn SR, et al. Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA. 1994; 272:1749-56. Google Scholar9. Hall JA, Dornan MC. What patients like about their medical care and how often they are asked: a meta-analysis of the satisfaction literature. Soc Sci Med. 1988; 27:935-9. Google Scholar10. Bertakis KD, Roter D, Putnam SM. The relationship of physician medical interview style to patient satisfaction. J Fam Pract. 1991; 32:175-81. Google Scholar11. Cassem EH. Depressive disorders in the medically ill. An overview. Psychosomatics. 1995; 36:S2-10. Google Scholar12. Spitzer RL, Kroenke K, Linzer M, Hahn SR, Williams JB, deGruy FV 3d, et al. Health-related quality of life in primary care patients with mental disorders. Results from the PRIME-MD 1000 Study. JAMA. 1995; 274:1511-7. Google Scholar13. Hays RD, Wells KB, Sherbourne CD, Rogers W, Spritzer K. Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses. Arch Gen Psychiatry. 1995; 52:11-9. Google Scholar14. Covinsky KE, Fortinsky RH, Palmer RM, Kresevic DM, Landefeld CS. Relation between symptoms of depression and health status outcomes in acutely ill hospitalized older persons. Ann Intern Med. 1997; 126:417-25. Google Scholar15. Mulrow CD, Williams JW Jr, Gerety MB, Ramirez G, Montiel OM, Kerber C. Case-finding instruments for depression in primary care settings. Ann Intern Med. 1995; 122:913-21. Google Scholar16. Whooley MA, Avins AL, Miranda J, Browner WS. A two-question screening instrument for depression in primary care Abstract. J Gen Intern Med. 1996; 11(Suppl 1):130. Google Scholar17. Williams JW, Mulrow CM, Kroenke K, Omori D, Badgett B, Dhanda R. Screening for depression: why ask 20 questions when 1 will do? Abstract J Gen Intern Med. 1996; 11(Suppl 1):131. Google Scholar18. Kathol RG, Wenzel RP. Natural history of symptoms of depression and anxiety during inpatient treatment on general medicine wards. J Gen Intern Med. 1992; 7:287-93. Google Scholar19. Katon W, Von Korff M, Lin E, Walker E, Simon GE, Bush T, et al. Collaborative management to achieve treatment guidelines. Impact on depression in primary care. JAMA. 1995; 273:1026-31. Google Scholar20. Sturm R, Wells KB. How can care for depression become more cost-effective? JAMA. 1995; 273:51-8. Google Scholar Author, Article, and Disclosure InformationAffiliations: Uniformed Services University of the Health Sciences, Bethesda, MD 20814Disclaimer: The opinions contained in this article are those of the author and are not to be construed as reflecting the views of the Department of the Army or the Department of Defense.Corresponding Author: Kurt Kroenke, MD, Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRelation between Symptoms of Depression and Health Status Outcomes in Acutely Ill Hospitalized Older Persons Kenneth E. Covinsky , Richard H. Fortinsky , Robert M. Palmer , Denise M. Kresevic , and C. Seth Landefeld Association of Symptoms of Depression with Diagnostic Test Charges among Older Adults Christopher M. Callahan , Joseph G. Kesterson , and William M. 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A primer for employee benefit design, decision makers, and an outcome research example 15 March 1997Volume 126, Issue 6Page: 463-465KeywordsCancer treatmentDementiaDepressionElderlyFatigueGeriatric depressionInsomniaMyocardial infarctionOutpatientsPsychiatry and mental health Issue Published: 15 March 1997 CopyrightCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...