Institute of General Practice, Technische Universität München, Munich, Germany.
Fam Pract. 2012 Jun;29(3):255-63. doi: 10.1093/fampra/cmr092. Epub 2011 Oct 19.
Findings of diagnostic studies using standardized psychiatric interviews as a gold standard suggest that family physicians (FPs) both under- and over-diagnose depression.
We systematically reviewed qualitative studies investigating how FPs diagnose depression and what their concepts of depression and the perceived barriers are when diagnosing depression.
We searched Medline, Embase, PsychInfo, reference lists and family practice journals to identify qualitative studies on primary care providers addressing at least one of the following issues: concepts, process and barriers relevant to diagnosing depression. Thematic synthesis was used for collecting data by line-by-line coding of the findings of the primary studies and for the development of descriptive and analytical themes.
Thirteen qualitative studies interviewing a total of 239 primary care providers met the inclusion criteria. Three distinct themes with nine subthemes that specify attitudes, diagnostic process and barriers while diagnosing depression were identified. The synthesis revealed that FPs use approaches to diagnose depression that are usually based on their knowledge of the patient's long-term history, an established patient-doctor relationship and a rule-out algorithm of other diagnoses. As such, these strategies markedly differ from the diagnostic criteria for depressive disorders that are used in psychiatrically oriented classification systems.
FPs believe to have sensible strategies for diagnosing depression that are different from the concepts operationalized in psychiatrically oriented classifications. In diagnostic studies, considering standardized psychiatric interviews uncritically as a gold standard for diagnosis of depression in primary care might be misleading.
以标准化精神科访谈作为金标准的诊断研究结果表明，家庭医生（FPs）对抑郁症的诊断存在低估和高估的情况。
我们系统地回顾了定性研究，这些研究调查了家庭医生如何诊断抑郁症，以及他们对抑郁症的概念和诊断抑郁症时感知到的障碍是什么。
我们检索了 Medline、Embase、PsychInfo、参考文献列表和家庭实践期刊，以确定针对初级保健提供者的定性研究，这些研究至少涉及以下一个问题：与诊断抑郁症相关的概念、过程和障碍。通过对主要研究结果进行逐行编码，收集数据，并开发描述性和分析性主题，采用主题综合法进行数据分析。
共有 13 项定性研究对总共 239 名初级保健提供者进行了访谈，符合纳入标准。确定了三个具有九个子主题的不同主题，这些主题明确了诊断抑郁症时的态度、诊断过程和障碍。综合结果表明，FPs 使用的诊断抑郁症的方法通常基于他们对患者长期病史、已建立的医患关系和排除其他诊断的算法的了解。因此，这些策略与精神病学导向的分类系统中使用的抑郁障碍诊断标准有明显的不同。
FPs 认为他们有合理的策略来诊断抑郁症，这些策略与精神病学导向的分类中所操作化的概念不同。在诊断研究中，不加批判地将标准化精神科访谈视为初级保健中诊断抑郁症的金标准可能会产生误导。
