Department and Institute of Psychiatry, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP, Brazil.
Clinics (Sao Paulo). 2009;64(7):629-35. doi: 10.1590/S1807-59322009000700004.
To investigate the recognition of depressive symptoms of major depressive disorder (MDD) by general practitioners.
MDD is underdiagnosed in medical settings, possibly because of difficulties in the recognition of specific depressive symptoms.
A cross-sectional study of 316 outpatients at their first visit to a teaching general hospital. We evaluated the performance of 19 general practitioners using Primary Care Evaluation of Mental Disorders (PRIME-MD) to detect depressive symptoms and compared them to 11 psychiatrists using Structured Clinical Interview Axis I Disorders, Patient Version (SCID I/P). We measured likelihood ratios, sensitivity, specificity, and false positive and false negative frequencies.
The lowest positive likelihood ratios were for psychomotor agitation/retardation (1.6) and fatigue (1.7), mostly because of a high rate of false positive results. The highest positive likelihood ratio was found for thoughts of suicide (8.5). The lowest sensitivity, 61.8%, was found for impaired concentration. The sensitivity for worthlessness or guilt in patients with medical illness was 67.2% (95% CI, 57.4-76.9%), which is significantly lower than that found in patients without medical illness, 91.3% (95% CI, 83.2-99.4%).
Less adequately identified depressive symptoms were both psychological and somatic in nature. The presence of a medical illness may decrease the sensitivity of recognizing specific depressive symptoms.
Programs for training physicians in the use of diagnostic tools should consider their performance in recognizing specific depressive symptoms. Such procedures could allow for the development of specific training to aid in the detection of the most misrecognized depressive symptoms.
调查全科医生对重性抑郁障碍（MDD）抑郁症状的识别情况。
MDD 在医疗环境中漏诊率较高，可能是因为难以识别特定的抑郁症状。
这是一项在教学综合医院首次就诊的 316 名门诊患者的横断面研究。我们使用初级保健精神障碍评估量表（PRIME-MD）评估 19 名全科医生的表现，以检测抑郁症状，并与 11 名使用轴 I 障碍定式临床检查患者版（SCID I/P）的精神科医生进行比较。我们测量了似然比、敏感性、特异性以及假阳性和假阴性频率。
精神运动性激越/迟滞（1.6）和疲劳（1.7）的阳性似然比最低，主要是因为假阳性率较高。自杀念头的阳性似然比最高（8.5）。注意力不集中的敏感性最低，为 61.8%。患有躯体疾病的患者的无价值感或内疚感的敏感性为 67.2%（95%CI，57.4-76.9%），显著低于无躯体疾病的患者的敏感性 91.3%（95%CI，83.2-99.4%）。
识别不足的抑郁症状既有心理性也有躯体性。躯体疾病的存在可能会降低识别特定抑郁症状的敏感性。
培训医生使用诊断工具的计划应考虑他们识别特定抑郁症状的表现。此类程序可以开发出特定的培训来帮助检测最易被忽视的抑郁症状。
