Katon W
Int J Psychiatry Med. 1987;17(1):93-112. doi: 10.2190/xe8w-glcj-kem6-39fh.
Major depression may be the most common medical or psychiatric disorder seen in primary medical care clinics, occurring in approximately 6 to 10 percent of the clinic populations. Despite this high prevalence rate, patients with depression often go undiagnosed or are misdiagnosed. The evidence suggests a multifactorial etiology for this problem. Many patients with depression selectively focus on the somatic components of their depressive syndrome and minimize or even deny affective and cognitive symptoms. Depression and medical disorders also often occur concomitantly with depression causing amplification of somatic complaints. Due to the unidimensional focus on the biomedical model many physicians only evaluate and treat the physical illness and do not diagnose the depression. This often leads to aggressive medical testing and treatment that carries the risk of iatrogenic injury (polysurgery, multiple tests and procedures, prescription of opiates and benzodiazepines). Several interventions are suggested to improve the diagnostic acumen of primary care physicians.
重度抑郁症可能是基层医疗诊所中最常见的医学或精神疾病，约占诊所患者人群的6%至10%。尽管患病率很高，但抑郁症患者常常未被诊断或被误诊。有证据表明，这个问题存在多因素病因。许多抑郁症患者选择性地关注其抑郁综合征的躯体成分，而将情感和认知症状最小化甚至否认。抑郁症和躯体疾病也常常同时出现，抑郁症会加剧躯体不适。由于对生物医学模式的单一关注，许多医生只评估和治疗身体疾病，而不诊断抑郁症。这往往导致激进的医学检查和治疗，存在医源性损伤（多次手术、多项检查和程序、阿片类药物和苯二氮卓类药物的处方）的风险。建议采取几种干预措施来提高初级保健医生的诊断敏锐度。
