Knowledge of the diagnostic criteria for major depression. A survey of mental health professionals.

Major depression, a mental disorder responsive to specific treatments, may be misdiagnosed by psychiatrists and other mental health personnel. Many patients referred to a depression clinic with other, generally less severe diagnoses were reevaluated by clinic staff and shown to meet DSM-III criteria for a major depressive episode. Discussions with referring therapists about these diagnostic discrepancies revealed frequent misconceptions about the diagnosis of major depression. In response to these observations, a questionnaire was devised to assess clinicians' knowledge about the DSM-III criteria for major depression. One hundred thirteen questionnaires were distributed to clinicians of varied disciplines and levels of experience, and 54 of these questionnaires were returned. Misconceptions about the DSM-III criteria for a major depressive episode were frequent among responders. The most common errors involved the incorrect assumption that vegetative signs and a distinct quality of mood are required for the diagnosis of major depression and that the diagnosis should not be made if chronic. Other major areas of confusion and potential causes of diagnostic error are discussed. Significantly, there were no differences in kind and number of errors when trainees and nontrainees were compared.