Department of General Practice and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
J Affect Disord. 2011 Oct;133(3):522-7. doi: 10.1016/j.jad.2011.05.001. Epub 2011 May 24.
Previous estimates of depression recognition in primary care are low and inconsistent. This may be due to registration artifacts and limited extraction efforts. This study investigated a) whether GPs' medical records demonstrate an accurate recognition of depression and b) which combinations of indications within the record most accurately reflect a diagnosis of depression.
GPs' registrations were compared with a reference standard, the Composite International Diagnostic Interview (CIDI), according to DSM-IV criteria. Six definitions of GPs' recognition of depression were tested using diagnostic codes, medication data, referral data and free text in the medical records. The Youden-index was used to select the optimal definition of recognition. Data were derived from the Netherlands Study of Depression and Anxiety. 816 primary care patients from 33 general practitioners were included in the vicinities of Amsterdam and Leiden, The Netherlands.
Registration of antidepressant prescriptions was the best single indicator of GPs' recognition of CIDI depression with a recognition rate of 0.43. The best combination of indicators increased the recognition rate to 0.69. All indications except the specific diagnostic codes for 'depressive disorder' and 'depressive feelings' were included in this definition.
Potential bias due to the selection of participating GPs might have influenced our recognition rates.
GPs are aware of mental health problems in most depressed patients, but labeling with specific diagnostic codes is weak. Researchers should consider that diagnostic coding alone is not an accurate measure of the diagnostic ability of depression and strongly underestimates the accuracy of the GP.
之前对初级保健中抑郁识别的估计较低且不一致。这可能是由于登记的人为因素和有限的提取工作。本研究调查了 a）家庭医生的医疗记录是否准确识别抑郁，以及 b）记录中哪些组合的指征最能反映抑郁的诊断。
根据 DSM-IV 标准，将家庭医生的登记与参考标准，即复合国际诊断访谈（CIDI）进行比较。使用诊断代码、药物数据、转诊数据和医疗记录中的自由文本测试了六种家庭医生识别抑郁的定义。使用 Youden 指数选择识别的最佳定义。数据来自荷兰抑郁和焦虑研究。来自阿姆斯特丹和莱顿附近的 33 名全科医生的 816 名初级保健患者被纳入荷兰。
抗抑郁药处方的登记是家庭医生识别 CIDI 抑郁的最佳单一指标，识别率为 0.43。最佳指标组合将识别率提高到 0.69。除了“抑郁障碍”和“抑郁情绪”的特定诊断代码外，所有指征都包含在该定义中。
由于选择参与的全科医生可能存在潜在的偏见，因此可能会影响我们的识别率。
大多数抑郁患者的家庭医生都意识到心理健康问题，但使用特定的诊断代码进行标记是薄弱的。研究人员应考虑到单独的诊断编码不是抑郁诊断能力的准确衡量标准，并且严重低估了全科医生的准确性。
