Screening tools for depression in primary care: The effects of culture, gender, and somatic symptoms on the detection of depression

Abstract

The effects of culture, gender, and somatic symptoms on the detection of depression see also p 292,332 Depression is projected to become the leading cause of disability and the second leading contributor to the global burden of disease by 2020. 1 It is estimated that the dev-astation caused by depression-defined as the number of years lost to death or disability-by 2020 will be surpassed only by heart disease. 2 Primary care physicians treat more than 50% of patients with mental disorders, and depressive disorders are accurately diagnosed in less than half of the patients who are affected. 3 A patient's culture, gender, and/or predominance of somatic symptoms can impede the detection of depression. This is reflected by biases found in self-reporting screening tools used to detect depression. In this article, we discuss the limitations of self-reporting screening tools for depression with respect to culture, gender , and somatic symptoms and suggest ways to use the results of screening tools to improve the detection of de-pressive disorders. LITERATURE SEARCH We conducted literature searches of the PubMed and PsychINFO databases (1990-2001) using the search terms Beck Depression Inventory, culture, and validity. Further searches of the PubMed database (1990-2001) included the additional search terms primary care, depression, Center for Epidemiological Studies Depression Scale, Patient Health Questionnaire, and General Health Questionnaire. We chose articles with relevance to the practice of primary care medicine, the use of depression screening tools in different cultures and different demographic groups, gender biases associated with depression screening tools, and the relationship between depression and somatic symptoms.