Three approaches to the recognition of affective disorders in family practice: clinical, pharmacological, and self-rating scales.

No single approach to the recognition of affective disorders worked in a ten percent sample of a family practice population, screened in the summer of 1975. Among 298 adults followed prospectively for two years, about six percent developed an affective disorder (3.8 percent anxiety, 1.9 percent depression, and 0.4 percent episodes of both). The sex ratio was predominantly female (2.7:1). Most of the cases were recognized by clinical problem lists, but 23 percent of the cases would have been missed without a computerized search of prescribed drug profiles. Self-rating tests (Zung for depression and Reeder for anxiety) performed poorly at predicting cases prospectively, and unimpressively in retrospect. The burden of these disorders is considerable, with a prevalence in this population of at least 19 percent. Of these cases, 22 percent had "mixed" episodes of depression, anxiety, and combinations seen at various visits. Criteria for diagnosis need to be clarified for more precise diagnosis, proper medication, as well as better estimates of incidence and patient load.