Dimensional perspective on the recognition of depressive symptoms in primary care

Abstract

Background Most studies of the recognition of depression in primary care have used a categorical definition of depression. This may overstate the extent of the problem.Aims Our objective was to investigate the relationship between severity and recognition of depression, and its modification by patient and practitioner characteristics.Method An association study in multiple consecutive adult cohorts of 18 414 primary care consultations drawn from a representative sample of 156 general practitioners in Hampshire, UK.Results There was a curvilinear relationship between the severity of depression and practitioners' ratings of depression. One case of probable depression was missed in every 28.6 consultations. Anxiety and unemployment altered the chances of recognition, but age, gender and deprivation scores did not.Conclusions A dimensional approach to severity of depression shows that general practitioners may be better able to recognise depression than previous categorical studies have suggested. Efforts to improve the care of depression should therefore focus on doctors who have been shown to have difficulty making the diagnosis and on improving the treatment of identified patients.